机械取栓治疗基底动脉闭塞的首通效应及预后影响因素分析

First pass effect and prognosis factor analysis of mechanical thrombectomy for basilar artery occlusion

目的 探讨机械取栓治疗基底动脉闭塞性急性缺血性卒中患者的首通效应(FPE)及预后的影响因素.方法 回顾性分析2016年6月至2022年6月河南省人民医院脑血管病中心采用机械取栓治疗的197例基底动脉闭塞性急性缺血性卒中患者的临床资料.根据是否实现FPE将患者分为FPE组与非FPE组,进行单因素分析和多因素logistic回归分析(向前法),确定FPE的影响因素.根据术后90 d改良Rankin量表评分(mRS),将患者分为预后良好组(mRS≤3分)与预后不良组(mRS>3分),同样进行单因素分析和多因素logistic回归分析(向前法),评估预后的影响因素.结果 与非FPE组(133例)患者比较,FPE组(64例)中女性患者占比高,入院美国国立卫生研究院卒中量表(NIHSS)评分较低,后循环Alberta卒中项目早期CT评分(pc-ASPECTS)和基底动脉CT血管成像(BATMAN)评分较高,心源性栓塞、基底动脉上段闭塞以及首选血栓抽吸者占比高,差异均具有统计学意义(均P<0.05);多因素logistic回归分析结果显示,女性(OR=2.27,95%CI:1.08~4.79)、入院 NIHSS 评分(OR=0.93,95%CI:0.89~0.98)、心源性栓塞(OR=2.12,95%CI:1.04~4.31)、基底动脉上段闭塞(OR=2.41,95%CI:1.23~4.72)及首选血栓抽吸治疗(OR=2.92,95%CI:1.46~5.83)均是FPE的影响因素(均P<0.05).与预后不良组(79例)比较,预后良好组(118例)患者入院时NIHSS评分较低,pc-ASPECTS及BATMAN评分较高,心源性栓塞占比高,穿刺至再通时间较短,FPE和成功再灌注者占比高,围手术期发生症状性颅内出血者占比低,差异均具有统计学意义(均P<0.05).多因素logistic回归分析结果显示,入院NIHSS评分(OR=1.09,95%CI:1.03~1.14)、FPE(OR=0.08,95%CI:0.04~0.18)均是术后90 d临床预后的影响因素(均P<0.05).结论 采用机械取栓治疗的基底动脉闭塞性急性缺血性卒中患者中,女性、入院NIHSS评分较低、心源性栓塞、基底动脉上段闭塞及首选血栓抽吸治疗的患者更易实现FPE;入院NIHSS评分较低、实现FPE的患者术后90 d的临床预后较好.

Objective To evaluate the first pass effect(FPE)and prognosis factors of mechanical thrombectomy in patients with acute ischemic stroke(AIS)caused by basilar artery occlusion(BAO).Methods We retrospectively analyzed the clinical data of 197 patients with BAO-AIS who underwent mechanical thrombectomy treatment at the Cerebrovascular Center of Henan Provincial People′s Hospital from June 2016 to June 2022.According to whether FPE was achieved,patients were divided into FPE group and non-FPE group,and univariate analysis and multivariate logistic regression analyses(forward method)were performed to ascertain the involved factors of FPE.According to the modified Rankin scale score(mRS)at 90 days after surgery,patients were divided into good outcome group(mRS≤3)and poor outcome group(mRS>3).Univariate analysis and multivariate logistic regression analyses(forward method)were also performed to evaluate the involved factors of prognosis.Results Compared with the non-FPE group(133 cases),the FPE group(64 cases)had higher proportions of female and cardioembolic stroke pathogenesis,lower admission NIHSS scores,higher posterior circulation-the Alberta stroke program early CT score(pc-ASPECTS)and the basilar artery on computed tomography angiography(BATMAN)scores,higher proportions of patients with basilar artery upside occlusion and undergoing preferred thrombus aspiration.Those differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that female(OR=2.27,95%CI:1.08-4.79),NIHSS score at admission(OR=0.93,95%CI:0.89-0.98),pathogenesis of cardioembolic stroke(OR=2.12,95%CI:1.04-4.31),basilar artery upside occlusion(OR=2.41,95%CI:1.23-4.72)and preferred thrombus aspiration(OR=2.92,95%CI:1.46-5.83)were the involved factors of FPE(all P<0.05).Compared with the group with poor outcome(79 cases),the group with good outcome(118 cases)had lower NIHSS scores,higher pc-ASPECTS and BATMAN scores at admission,a higher proportion of cardioembolic stroke pathogenesis,FPE and successful reperfusion,shorter puncture to reperfusion time,and a lower proportion of symptomatic intracerebral hemorrhage during the perioperative period.Those differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that NIHSS score at admission(OR=1.09,95%CI:1.03-1.14)and FPE(OR=0.08,95%CI:0.04-0.18)were related factors to clinical outcome at 90 days after surgery(all P<0.05).Conclusions Among patients with BAO-AIS treated with mechanical thrombectomy,female,lower NIHSS scores at admission,pathogenesis of cardiogenic embolic stroke,basilar artery upside occlusion and preferred thrombus aspiration are associated with higher chance of FPE.Patients with lower NIHSS scores at admission and FPE have a better clinical prognosis at 90 days after surgery.