急性缺血性脑卒中患者支架取栓术失败的影响因素及补救性Solitaire AB支架置入的可行性分析

Influencing factors for stent thrombectomy failure in patients with acute ischemic stroke and feasibility analysis of remedial Solitaire AB stent implantation

目的 探究急性缺血性脑卒中(AIS)患者支架取栓术失败的影响因素及补救性Solitaire AB支架置入的可行性。方法 以2018-10—2020-03沧州市人民医院160例AIS患者为研究对象,均给予支架取栓术治疗,根据手术疗效分为成功组及失败组,分析AIS患者支架取栓术失败的影响因素;根据术后是否置入Solitaire AB支架将失败组分为支架置入组及对照组,比较2组疗效、脑血管血流状况、神经营养因子水平及预后。结果 160例AIS患者中支架取栓术失败率为26.25%(42/160),失败组中年龄≥60岁、合并高脂血症、既往有脑卒中史、闭塞部位为颈内动脉的比例及入院时NIHSS评分高于成功组,发病至股动脉穿刺时间、穿刺至再通时间、发病至再通时间长于成功组,血栓切除次数多于成功组(P<0.05)。颈内动脉闭塞(OR=2.143,95%CI:1.411~3.253)、入院时NIHSS评分升高(OR=1.677,95%CI:1.138~2.472)、发病至再通时间延长(OR=2.063,95%CI:1.041~4.088)、血栓切除次数增加(OR=1.902,95%CI:1.412~2.562)是影响AIS患者支架取栓术失败的危险因素(P<0.05)。支架置入组及对照组总有效率对比差异无统计学意义(90.48%比61.90%,P>0.05)。支架置入组治疗后缺血面积小于对照组(P<0.05),CBV、CBF大于对照组(P<0.05),NSE、S-100β水平低于对照组(P<0.05),2组mRS评分对比差异无统计学意义(P>0.05)。结论 颈内动脉闭塞、入院时NIHSS评分升高、发病至再通时间延长是AIS患者支架取栓术失败的危险因素,对支架取栓术失败患者给予补救性Solitaire AB支架置入治疗,可改善脑组织血流灌注,促进神经功能恢复。

Objective To investigate the influencing factors of stent thrombectomy failure in patients with acute ischemic stroke(AIS)and the feasibility of remedial Solitaire AB stent implantation.Methods Totally 160 patients with AIS from October 2018 to March 2020 were selected as the study subjects,and they were treated with stent thrombectomy.The patients were divided into success group and failure group according to the surgical efficacy,and the influencing factors of stent thrombectomy failure in patients with AIS were analyzed.According to whether Solitaire AB stent was implanted after surgery or not,the patients in failure group were classified into stent implantation group and control group,and the therapeutic efficacy,cerebrovascular blood flow status,neurotrophic factors levels and prognosis were compared between both groups.Results Among 160 patients with AIS,the stent thrombectomy failure rate was 26.25%(42/160).The proportions of patients with age≥60 years old,hyperlipidemia,previous history of stroke and internal carotid artery occlusion and NIHSS score at admission were higher in failure group than those in success group,and the time from onset to femoral artery puncture,time from puncture to recanalization and time from onset to recanalization were longer than those in success group,and the number of thrombectomy was more than that in success group(P<0.05).Internal carotid artery occlusion(OR=2.143,95%CI:1.411-3.253),increased NIHSS score at admission(OR=1.677,95%CI:1.138-2.472),prolonged time from onset to recanalization(OR=2.063,95%CI:1.041-4.088),and increased number of thrombectomy(OR=1.902,95%CI:1.412-2.562)were the risk factors for stent thrombectomy failure in patients with AIS(P<0.05).There was no significant difference in the total effective rate of treatment between the two groups(90.48%vs 61.90%,P>0.05).After treatment,the ischemic area in observation group was smaller than that in control group(P<0.05),and the CBV and CBF were larger than those in control group(P<0.05).After treatment,the levels of NSE and S-100βwere lower than those in control group(P<0.05).There was no significant difference in mRS score between both groups(P>0.05).Conclusion Internal carotid artery occlusion,increased NIHSS score at admission,and prolonged time from onset to recanalization are risk factors of stent thrombectomy failure in patients with AIS.Remedial Solitaire AB stent implantation for patients with stent thrombectomy failure can improve the cerebral tissue blood perfusion and promote the recovery of neurological function.