急性后循环大动脉闭塞性脑卒中血管内治疗的临床预后分析

Clinical prognosis of acute posterior circulation large artery occlusive stroke via endovascular therapy

目的总结发病6 h内经血管内治疗的后循环大动脉闭塞性脑卒中患者的临床特征,探讨不良预后的相关危险因素。方法收集2017年1月—2023年6月江苏大学附属人民医院神经外科43例6 h以内急性后循环大动脉闭塞性脑卒中患者的临床资料,记录患者临床基线特征以及血管再通率、症状性颅内出血率、90 d良好预后[改良Rankin量表(mRS)评分≤2分]率和病死率。采用单因素及多因素Logistic回归分析探讨造成预后不良(mRS评分>2分)的相关危险因素。结果血管内治疗后,血管成功再通34例,症状性颅内出血4例。90 d随访预后良好患者20例,预后不良12例,死亡11例。单因素分析提示,2组仅术前NIHSS评分差异有统计学意义(P<0.05);二元Logistic回归分析结果显示,术前高NIHSS评分是预后不佳的独立危险因素。结论早期血管内治疗可明显提高急性后循环大动脉闭塞性脑卒中患者血管再通率,改善预后。术前NIHSS评分可作为独立影响因素判断患者预后情况。

Objective To summarize the clinical characteristics of patients with acute posterior circulation large artery occlusive stroke within 6 hours via endovascular therapy and analyze the risk factors for poor prognosis.Methods Clinical data of 43 patients with acute posterior circulation large artery occlusive stroke within 6 hours from January 2017 to June 2023 in the Department of Neurosurgery of the Affiliated People's Hospital of Jiangsu University were collected.The baseline data,the vascular recanalization rate,symptomatic intracranial hemorrhage rate,90 d good prognosis[modified Rankin Scale(mRS)score≤2]rate,and mortality were analyzed retrospectively.Univariate and multivariate Logistic regression analyses were applied to analyze the risk factors associated with poor prognosis(mRS score>2).Results After endovascular treatment,successful revascularization was achieved in 34 cases,and 4 cases developed symptomatic intracranial hemorrhage.At the 90-day follow-up,20 patients had good outcomes,12 had poor outcomes,and 11 died.Univariate analysis suggested that there was a statistically significant difference in preoperative NIHSS scores between the two groups(P<0.05).Binary logistic regression analysis showed that a high preoperative NIHSS score was an independent risk factor for poor prognosis.Conclusion Early endovascular treatment can significantly improve the revascularization rate and prognosis of patients with acute posterior circulation large artery occlusion stroke.Preoperative NIHSS score can be used as an independent influencing factor to predict the prognosis of patients.