急性颅内大血管闭塞性脑梗死患者血栓病理对机械取栓后出血转化的影响

Effect of thrombus pathology on hemorrhagic transformation after mechanical thrombectomy in patients with acute intracranial large vessel occlusive cerebral infarction

目的:分析急性颅内大血管闭塞性脑梗死患者血栓病理对机械取栓后出血转化的影响。方法:收集2020年6月~2022年5月太和县人民医院收治的145例急性颅内大血管闭塞性脑梗死患者的临床资料。依据机械取栓后出血转化情况分为出血转化组和非出血转化组,比较两组基线资料及血栓病理,并分析影响急性颅内大血管闭塞性脑梗死患者机械取栓后出血转化的血栓病理因素。结果:145例急性颅内大血管闭塞性脑梗死患者中,30例(20.69%)机械取栓后发生出血转化。出血转化组患者入院时NIHSS评分、多次取栓及血栓病理为红细胞富集占比高于非出血转化组(P<0.05),并与机械取栓后出血转化均呈正相关(P<0.05)。多因素Logistic回归分析显示,入院时NIHSS评分高、多次取栓、血栓病理为红细胞富集均是急性颅内大血管闭塞性脑梗死患者机械取栓后出血转化的危险因素(P<0.05)。结论:急性颅内大血管闭塞性脑梗死患者血栓病理为红细胞富集会增加机械取栓后出血转化风险。

Objective:To investigate the effect of thrombus pathology on hemorrhagic transformation after mechanical thrombectomy in patients with acute intracranial large vessel occlusive(LVO)cerebral infarction.Methods:Clinical data were collected from 145 patients with acute intracranial LVO cerebral infarction treated in People′s Hospital of Taihe County between June 2020 and May 2022.Based on the occurrence of hemorrhagic transformation after mechanical thrombectomy,the patients were divided into hemorrhagic transformation group and non-hemorrhagic transformation group.Baseline data and thrombus pathology were compared between the two groups,and thrombus pathological factors influencing hemorrhagic transformation were analyzed.Results:Thirty out of the 145 patients(20.69%)developed hemorrhagic transformation after mechanical thrombectomy.Patients in the hemorrhagic transformation group had higher National Institutes of Health Stroke Scale(NIHSS)scores at admission,greater frequency of multiple thrombectomies,and a larger proportion of red blood cell enrichment in thrombi compared to those in the non-hemorrhagic transformation group(P<0.05).All these factors were positively correlated with hemorrhagic transformation after mechanical thrombectomy(P<0.05).Multivariate logistic regression analysis showed that higher NIHSS scores at admission,multiple thrombectomies,and red blood cell enrichment in thrombi were all risk factors for hemorrhagic transformation after mechanical thrombectomy in patients with acute intracranial LVO cerebral infarction(P<0.05).Conclusion:Red blood cell enrichment in thrombi may increase the risks of hemorrhagic transformation in patients with acute intracranial LVO cerebral infarction following mechanical thrombectomy.