Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and dis...Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.展开更多
目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾...目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾性分析,根据治疗后90 d改良Rankin量表(mRS)评分将患者分为预后不良(mRS评分>2分)组(n=58)和预后良好(mRS评分≤2分)组(n=64),采用logistic回归分析影响LVOS患者血管内再通治疗预后因素,并构建预测模型。结果预后不良组年龄≥60岁、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分≥16分、症状性颅内出血占比高于预后良好组,血栓负荷量评分(CBS)≥6分、入院时Alberta卒中项目早期CT评分(the Alberta stroke program early CT score,ASPECTS)>7分占比低于预后良好组(P<0.05或0.001);logistic回归分析显示,年龄≥60岁、CBS评分<6分、入院时NIHSS评分≥16分、入院时ASPECTS评分≤7分、症状性颅内出血是LVOS血管内再通治疗患者预后不良的危险因素(P<0.05);ROC曲线显示,预测模型预测LVOS血管内再通治疗患者预后不良的AUC为0.885,95%CI为0.815~0.936(P<0.001),预测模型具有良好的预测效能;以临床诊断结果(治疗后90 d mRS评分)为金标准,模型预测LVOS血管内再通治疗患者预后不良的准确度、敏感度及特异度分别为97.54%、98.28%及96.88%,与实际诊断结果的Kappa值为0.951。结论LVOS血管内再通治疗患者预后不良与年龄、CBS评分、入院时NIHSS评分、入院时ASPECTS评分、症状性颅内出血等因素有关,构建预测模型对LVOS血管内再通治疗患者预后不良具有良好的预测价值。展开更多
目的探讨症状性慢性颈动脉闭塞病人的临床特征、血管内治疗方法及影响预后的因素,以提高诊疗水平。方法回顾性分析20例症状性慢性颈动脉闭塞病人的临床资料,均采用血管内再开通手术。术后疗效采用美国国立卫生研究院卒中量表(national i...目的探讨症状性慢性颈动脉闭塞病人的临床特征、血管内治疗方法及影响预后的因素,以提高诊疗水平。方法回顾性分析20例症状性慢性颈动脉闭塞病人的临床资料,均采用血管内再开通手术。术后疗效采用美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)及3个月后改良Rankin量表(modified rankin scale,m RS)进行评估。结果再开通13例,余7例未再开通。再开通组术后7 d NIHSS评分及3个月后m RS评分均低于未再开通组(P<0.05),且两组术后并发症无统计学差异(P>0.05)。Logistic回归分析显示血管再开通(OR=0.46,P=0.006)及术前NIHSS评分(OR=8.86,P=0.035)与术后3个月m RS评分相关。结论血管内治疗对于有症状的慢性颈动脉闭塞病人较安全,并且可以降低预后残障程度。展开更多
目的：比较颈动脉闭塞血管内再通术和颈动脉狭窄支架置入术（CAS）患者手术成功率和围手术期及近期不良事件，探讨颈动脉闭塞血管内再通术的疗效。方法回顾性分析接受颈动脉 CAS 的症状性颈动脉狭窄和颈动脉闭塞再通术患者的人口统计学...目的：比较颈动脉闭塞血管内再通术和颈动脉狭窄支架置入术（CAS）患者手术成功率和围手术期及近期不良事件，探讨颈动脉闭塞血管内再通术的疗效。方法回顾性分析接受颈动脉 CAS 的症状性颈动脉狭窄和颈动脉闭塞再通术患者的人口统计学资料、危险因素及颈动脉狭窄 CAS 术和闭塞再通术中及术后相关因素、围手术期及随访结果。结果共有54例颈动脉狭窄和17例颈动脉闭塞患者，54例颈动脉狭窄患者均成功置入支架而纳入狭窄组；17例颈动脉闭塞患者，再通失败2例，成功再通并置入支架患者15例并纳入闭塞组。狭窄组术后残余狭窄率为0～30％，平均为13％～18％，技术成功率为100％。闭塞组术后残余狭窄率为0～30％，平均为17％～22％，但是再通技术成功率为88．2％。两组病例中狭窄部位、术后心动过缓、术后低血压及高灌注综合征差异无统计学意义（P ＞0．05），而支架长度、球囊预扩、保护装置的应用与否、支架长度及手术时间差异有统计学意义（P ＜0．01）。多元 Logistic 回归分析表明闭塞组不良事件发生率与支架长度、保护装置的应用与否、支架长度及手术时间等差异无统计学意义。围手术期并发症：狭窄组小中风2例，大中风0例；闭塞组小中风1例、大中风1例。总体不良事件发生率为5．8％，其中狭窄组为3．7％，闭塞组为13．3％。但颈动脉闭塞组与狭窄组比较差异无统计学意义（P＞0．05）；1月后总临床成功率为98．6％。2月至1．5年随访，无支架内再狭窄及不良事件发生。结论颈内动脉闭塞再通术是安全可行的，患者耐受性较好，但由于颈动脉闭塞病例数较少，技术成功率及并发症发生率可能过高，潜在的严重并发症可能被低估，今后还需进一步的研究。展开更多
文摘Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.
文摘目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾性分析,根据治疗后90 d改良Rankin量表(mRS)评分将患者分为预后不良(mRS评分>2分)组(n=58)和预后良好(mRS评分≤2分)组(n=64),采用logistic回归分析影响LVOS患者血管内再通治疗预后因素,并构建预测模型。结果预后不良组年龄≥60岁、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分≥16分、症状性颅内出血占比高于预后良好组,血栓负荷量评分(CBS)≥6分、入院时Alberta卒中项目早期CT评分(the Alberta stroke program early CT score,ASPECTS)>7分占比低于预后良好组(P<0.05或0.001);logistic回归分析显示,年龄≥60岁、CBS评分<6分、入院时NIHSS评分≥16分、入院时ASPECTS评分≤7分、症状性颅内出血是LVOS血管内再通治疗患者预后不良的危险因素(P<0.05);ROC曲线显示,预测模型预测LVOS血管内再通治疗患者预后不良的AUC为0.885,95%CI为0.815~0.936(P<0.001),预测模型具有良好的预测效能;以临床诊断结果(治疗后90 d mRS评分)为金标准,模型预测LVOS血管内再通治疗患者预后不良的准确度、敏感度及特异度分别为97.54%、98.28%及96.88%,与实际诊断结果的Kappa值为0.951。结论LVOS血管内再通治疗患者预后不良与年龄、CBS评分、入院时NIHSS评分、入院时ASPECTS评分、症状性颅内出血等因素有关,构建预测模型对LVOS血管内再通治疗患者预后不良具有良好的预测价值。
文摘目的探讨症状性慢性颈动脉闭塞病人的临床特征、血管内治疗方法及影响预后的因素,以提高诊疗水平。方法回顾性分析20例症状性慢性颈动脉闭塞病人的临床资料,均采用血管内再开通手术。术后疗效采用美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)及3个月后改良Rankin量表(modified rankin scale,m RS)进行评估。结果再开通13例,余7例未再开通。再开通组术后7 d NIHSS评分及3个月后m RS评分均低于未再开通组(P<0.05),且两组术后并发症无统计学差异(P>0.05)。Logistic回归分析显示血管再开通(OR=0.46,P=0.006)及术前NIHSS评分(OR=8.86,P=0.035)与术后3个月m RS评分相关。结论血管内治疗对于有症状的慢性颈动脉闭塞病人较安全,并且可以降低预后残障程度。
文摘目的：比较颈动脉闭塞血管内再通术和颈动脉狭窄支架置入术（CAS）患者手术成功率和围手术期及近期不良事件，探讨颈动脉闭塞血管内再通术的疗效。方法回顾性分析接受颈动脉 CAS 的症状性颈动脉狭窄和颈动脉闭塞再通术患者的人口统计学资料、危险因素及颈动脉狭窄 CAS 术和闭塞再通术中及术后相关因素、围手术期及随访结果。结果共有54例颈动脉狭窄和17例颈动脉闭塞患者，54例颈动脉狭窄患者均成功置入支架而纳入狭窄组；17例颈动脉闭塞患者，再通失败2例，成功再通并置入支架患者15例并纳入闭塞组。狭窄组术后残余狭窄率为0～30％，平均为13％～18％，技术成功率为100％。闭塞组术后残余狭窄率为0～30％，平均为17％～22％，但是再通技术成功率为88．2％。两组病例中狭窄部位、术后心动过缓、术后低血压及高灌注综合征差异无统计学意义（P ＞0．05），而支架长度、球囊预扩、保护装置的应用与否、支架长度及手术时间差异有统计学意义（P ＜0．01）。多元 Logistic 回归分析表明闭塞组不良事件发生率与支架长度、保护装置的应用与否、支架长度及手术时间等差异无统计学意义。围手术期并发症：狭窄组小中风2例，大中风0例；闭塞组小中风1例、大中风1例。总体不良事件发生率为5．8％，其中狭窄组为3．7％，闭塞组为13．3％。但颈动脉闭塞组与狭窄组比较差异无统计学意义（P＞0．05）；1月后总临床成功率为98．6％。2月至1．5年随访，无支架内再狭窄及不良事件发生。结论颈内动脉闭塞再通术是安全可行的，患者耐受性较好，但由于颈动脉闭塞病例数较少，技术成功率及并发症发生率可能过高，潜在的严重并发症可能被低估，今后还需进一步的研究。
