阶梯式血管内治疗策略应用于颅内动脉粥样硬化性狭窄所致急性大血管闭塞的临床研究

Clinical study of step-by-step endovascular treatment strategy in acute large vessel occlusion caused by intracranial atherosclerotic stenosis

目的探讨阶梯式血管内治疗策略应用于颅内动脉粥样硬化性狭窄(ICAS)所致急性大血管闭塞(ALVO)患者的安全性和有效性,并进一步分析影响其预后的独立危险因素。方法选取2021年1月-2023年5月在阜阳市人民医院接受阶梯式血管内治疗的55例ICAS所致ALVO患者。阶梯式血管内治疗的过程包括机械取栓(MT)、球囊扩张(BA)和支架植入(RS),依据患者在治疗过程中所采用的组合方式分为MT+BA组和MT+BA+RS组,比较两组患者的一般资料和预后。采用二分类Logistic回归分析确定影响接受阶梯式血管内治疗患者预后的独立影响因子。结果与MT+BA组比较,MT+BA+RS组年龄较轻[(60.70±10.71)岁vs(67.67±12.17)岁,P=0.035]、美国国立卫生研究院卒中量表(NIHSS)评分较低[(16.59±7.59)分vs(21.78±7.27)分,P=0.022]、手术时间更长[(92.35±17.09)min vs(82.22±12.03)min,P=0.028];两组在性别、高血压、糖尿病、心房颤动、闭塞部位、出血性转化(HT)、症状性颅内出血(SICH)、3个月时预后良好率和死亡率方面对比差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,NIHSS评分高(OR=1.276,95%CI=1.112~1.464,P<0.001)、手术时间长(OR=1.064,95%CI=1.001~1.131,P=0.048)和HT(OR=0.067,95%CI=0.005~0.883,P=0.040)是导致阶梯式血管内治疗患者预后不良的独立危险因素。结论阶梯式血管内治疗策略用于ICAS所致ALVO患者安全、有效,NIHSS评分高、手术时间长和HT是影响其预后的独立危险因素。

Objective To explore the safety and effectiveness of step-by-step endovascular treatment in patients with acute large vessel occlusion(ALVO)caused by intracranial atherosclerotic stenosis(ICAS),and to further analyze the independent risk factors which affecting the prognosis.Methods A total of 55 patients with ICAS caused by ALVO who received step-by-step endovascular treatment at Fuyang People's Hospital from January 2021 to May 2023 were included.The process of step-by-step endovascular treatment included mechanical thrombectomy(MT),balloon angioplasty(BA),and rescue stenting(RS).Patients were divided into the MT+BA group and the MT+BA+RS group based on the combination method used during the treatment process.The baseline data and prognosis of the two groups of patients were compared.Binary logistic regression analysis was used to determine independent influencing factors on the prognosis of patients receiving step-by-step endovascular treatment.Results Compared with the MT+BA group,the MT+BA+RS group had younger age[(60.70±10.71)years vs(67.67±12.17)years,P=0.035],lower National Institute of Health Stroke Scale(NIHSS)score[(16.59±7.59)points vs(21.78±7.27)points,P=0.022],longer surgical time[(92.35±17.09)minutes vs(82.22±12.03)minutes,P=0.028].There was no significant difference between the two groups in terms of gender,hypertension,diabetes,atrial fibrillation,occlusive site,hemorrhagic transformation(HT),symptomatic intracranial hemorrhage(SICH),and the number of patients with good prognosis in three months and mortality(P>0.05).Logistic regression analysis showed that high NIHSS score(OR=1.276,95%CI=1.112-1.464,P<0.001),long surgical time(OR=1.064,95%CI=1.001-1.131,P=0.048),and HT(OR=0.067,95%CI=0.005-0.883,P=0.040)were independent risk factors for poor prognosis in patients undergoing step-by-step endovascular therapy.Conclusions ICAS caused by ALVO patients are safe and effective in receiving step-by-step endovascular treatment.High NIHSS score,long surgical time and HT are independent risk factors affecting their prognosis.