颅内动脉钙化在急性缺血性脑卒中机械取栓中的应用价值

Application value of intracranial arterial calcification in mechanical thrombectomy for acute ischemic stroke

目的通过测算颅内大、中血管闭塞的急性缺血性脑卒中患者的颅内动脉钙化(IAC)改良Woodcock钙化评分,推测其对血管内治疗和手术结果的影响。方法收集青岛市市立医院2017年1月—2021年7月,因大或中等血管闭塞导致的缺血性卒中接受机械取栓的患者,统计人口统计学和变量包括年龄、性别、NIHSS评分等。采用皮尔逊相关性分析、线性回归分析、Logistic回归分析建模,确定症状性IAC与结局之间的相关性,使用与结局具有统计学显著相关性变量分析进行调整,P<0.05为差异具有统计学意义。结果高达53.6%(74例)的急性缺血性脑卒中患者,在入院CT成像上可识别颅内血管钙化。同时发现病变血管同侧的改良Woodcock评分在预测大血管闭塞机械取栓预后有一定的价值,Logistics回归分析显示同侧钙化评分与改良Rankin评分(mRS)呈负相关(P=0.026)、使用球囊与Rankin呈正相关(P=0.035)。分析发现低密度脂蛋白高的患者,住院总费用、手术材料费用、植入支架的可能性越高,再通比例更低。结论颅内动脉钙化评分在急性缺血性脑卒中机械取栓中有一定的应用价值。低密度脂蛋白高的患者,住院总费用、手术材料费用、植入支架可能性更高,术后再通比例更低。

Objective To investigate the modified Woodcock score of intracranial arterial calcification(IAC)in acute ischemic stroke patients with intracranial large or medium vessel occlusion and its impact on the outcome of endovascular treatment and surgery.Methods The patients who underwent mechanical thrombectomy for acute ischemic stroke due to large or medium vessel occlusion in our hospital from January 2017 to July 2021 were enrolled,and related demographic and clinical variables were analyzed,including age,sex,and National Institutes of Health Stroke Scale(NIHSS).Pearson correlation analysis,linear regression analysis,and logistic regression analysis were used for modeling to determine the association between symptomatic IAC and outcome,and the variables that were significantly associated with outcome were used for adjustment,with P<0.05 as statistically significant.Results Of all acute ischemic stroke patients,74(53.6%)were found to have intracranial vascular calcification on CT images on admission.The modified Woodcock score on the ipsilateral side of the diseased vessels had a certain value in predicting the prognosis of mechanical thrombectomy for large vessel occlusion,and the logistic regression analysis showed that calcification score on the ipsilateral side was negatively correlated with the modified Rankin Scale(mRS)score(P=0.026),and the use of balloons was positively correlated with mRS score(P=0.035).Data analysis showed that the patients with a high level of low-density lipoprotein(LDL)tended to have high total hospital costs,high costs of surgical materials,a high possibility of stent implantation,and a low recanalization rate.Conclusion Intracranial arterial calcification score has a certain application value in mechanical thrombectomy for acute ischemic stroke.Patients with high LDL tend to have high total hospital costs,high costs of surgical materials,a high possibility of stent implantation,and a low recalculation rate after surgery.