前循环急性大血管闭塞性卒中成功再通后发生恶性脑水肿的相关预测因素及结局分析

Predictors and outcome of malignant brain edema after successful recanalization for acute large vessel occlusion stroke in the anterior circulation

目的分析前循环大血管闭塞性卒中(ALVOS)成功再通后发生恶性脑水肿(MBE)的发生率、相关预测因素及临床结局。方法回顾性分析2018年10月—2020年11月在西南医科大学附属医院神经内科因前循环ALVOS行血管内治疗(EVT)后成功再通的患者130例,收集患者详细资料,采用单因素和多因素Logistic回归分析ALOVS成功再通后发生MBE的发生率、预测因素,并绘制ROC曲线分析。采用90 d改良Rankin量表(mRS)评分评价临床结局。结果共纳入130例患者(男性62.3%),其中26例(20.0%)发生MBE,多因素分析显示,NIHSS评分(OR=1.180,95%CI 1.077~1.293,P<0.001)、取栓次数>3次(OR=3.759,95%CI 1.195~11.825,P=0.024)是前循环ALVOS成功再通后发生MBE的独立影响因素。发生MBE是90 d不良功能预后(OR=5.296,95%CI 1.855~15.122,P=0.002)和90 d死亡率(OR=34.850,95%CI 8.330~145.802,P<0.001)的独立危险因素。ROC曲线分析显示,NIHSS评分预测ALVOS成功再通后发生MBE的曲线下面积为0.813(95%CI 0.719~0.908,P<0.05),敏感度75.0%,特异度73.1%;取栓次数>3次的曲线下面积为0.721(95%CI 0.605~0.838,P<0.05),敏感度65.4%,特异度78.8%。结论急性大血管闭塞性卒中成功再通后发生MBE仍不少见,并与不良的临床结局相关,NIHSS评分和取栓次数>3次是预测MBE发生的独立影响因素。

Objective To investigate the incidence,predictors,and clinical outcome of malignant brain edema(MBE)after successful recanalization for acute anterior circulation large vessel occlusion stroke(ALVOS).Methods We retrospectively collected the data of 130 patients with ALVOS who underwent successful recanalization with endovascular treatment at the Department of Neurology of The Affiliated Hospital of Southwest Medical University from October 2018 to November 2020.Univariable and multivariable logistic regression analyses were performed to explore the incidence rate and predictors of MBE after successful recanalization for ALVOS.The receiver operating characteristic(ROC)curve was created.The clinical outcome was evaluated using the modified Rankin Scale at 90 days.Results Among the included 130 patients(male,62.3%),26(20.0%)developed MBE.The multivariable logistic regression analysis showed that the National Institutes of Health Stroke Scale(NIHSS)score(OR=1.180,95%CI 1.077-1.293,P<0.001)and the number of clot retrieval attempts>3(OR=3.759,95%CI 1.195-11.825,P=0.024)were independent factors affecting the development of MBE after successful recanalization in ALVOS.MBE was an independent risk factor for a poor outcome(OR=5.296,95%CI 1.855-15.122,P=0.002)and mortality(OR=34.850,95%CI 8.330-145.802,P<0.001)at 90 days.According to the ROC curve analysis,the area under the curve for the NIHSS score predicting the occurrence of MBE after successful recanalization in ALVOS was 0.813(95%CI 0.719-0.908,P<0.05),with a specificity of 73.1%and a sensitivity of 75.0%.The area under the curve of the number of clot retrieval attempts>3 was 0.721(95%CI 0.605-0.838,P<0.05),with a specificity of 78.8%and a sensitivity of 65.4%.Conclusion MBE following successful recanalization is not rare in patients with ALVOS,which is associated with a poor clinical outcome,and the NIHSS score and the number of clot retrieval attempts>3 are independent predictors of the development of MBE.