CTA评分系统对颈动脉狭窄患者颈动脉支架植入术后结局的预测价值

Predictive value of CTA scoring system for outcome of carotid artery stenting in patients with carotid artery stenosis

目的探讨CT血管造影(CTA)评分系统对颈动脉狭窄患者颈动脉支架植入术(CAS)后结局的预测价值。方法前瞻性分析2019年5月至2022年5月在海安市人民医院接受CAS治疗的94例颈动脉狭窄患者,治疗3个月后根据改良Rankin量表(mRS)对患者进行评分,将mRS≤2分的58例设为预后良好组,将mRS>2分的36例设为预后不良组。2组患者术前均行CTA检查,利用Alberta卒中项目早期CT评分(ASPECTS)、区域软脑膜侧支循环评分(rLMC)、Tan侧支循环评分(Tan)评估患者CTA影像,采用多因素Logistic回归分析可能影响CAS治疗结局的危险因素,并采用ROC曲线评价CTA评分系统对颈动脉狭窄患者CAS治疗后结局的预测价值。结果预后不良组术前美国国立卫生研究院卒中量表(NIHSS)评分高于预后良好组,ASPECTS评分、rLMC评分、Tan评分均低于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示NIHSS评分、ASPECTS评分、rLMC评分、Tan评分是颈动脉狭窄患者CAS治疗结局的影响因素(P<0.05)。ROC曲线分析结果显示ASPECTS评分、rLMC评分、Tan评分均能预测颈动脉狭窄患者CAS治疗结局,但联合预测价值最高。结论颈动脉狭窄患者术前ASPECTS评分、rLMC评分、Tan评分均能有效预测颈动脉狭窄患者CAS治疗结局,且三者联合预测价值最高,能辅助医师评估患者预后情况,为治疗方案的制定提供参考依据。

Objective To evaluate the predictive value of computed tomography angiography(CTA)scoring system for the outcome of carotid artery stenting(CAS)in patients with carotid artery stenosis.Methods Ninety‑four patients with carotid artery stenosis who underwent CAS in Department of Neurology,Hai’an People’s Hospital from May 2019 to May 2022 were prospectively analyzed.After 3 months of treatment,the functional outcome was assessed according to modified Rankin scale(mRS).Fifty‑eight patients with mRS≤2 were assigned to good prognosis group,and 36 patients with mRS>2 were classified into poor prognosis group.All the patients underwent CTA before operation.CTA images were assessed by the Alberta Stroke Program Early CT Score(ASPECTS),regional leptomeningeal collateral score(rLMC),and Tan score.Multivariate logistic regression analysis was conducted to screen the risk factors for the outcome of CAS treatment,and receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of CTA scoring system for the outcome of CAS treatment in patients with carotid artery stenosis.Results Before CAS treatment,the poor prognosis group had higher National Institutes of Health Stroke Scale(NIHSS)score,and lower ASPECTS,rLMC and Tan scores than the good prognosis group(P<0.05).Multivariate logistic regression analysis revealed that NIHSS,ASPECTS,rLMC and Tan scores were influencing factors for CAS treatment outcome in patients with carotid artery stenosis(P<0.05).ROC curve analysis showed that ASPECTS,rLMC and Tan scores had certain predictive value for CAS treatment outcome of patients with carotid artery stenosis,the combination of above scores could achieve the best predictive efficacy.Conclusion Preoperative ASPECTS,rLMC,and Tan scores can effectively predict CAS treatment outcome in patients with carotid artery stenosis,and the combination of the three scores can obtain higher predictive value.It can assist physicians to assess the prognosis and make treatment plan.