摘要
目的探讨急性卒中血管内血栓切除术后血管再通的影响因素。方法前瞻性收集2017年1月至2018年12月在我院就诊并接受血管内血栓切除术的急性脑卒中患者72例。所有患者均于治疗前进行MRI检查,收集扩散加权成像(DWI)梗死体积、血管再通程度[改良脑梗死溶栓(mTICI)评分方法评估]、功能预后(3个月mRS评分)和其他临床数据。比较不同血管再通程度间各参数差异。Spearman等级相关分析及多元逻辑回归分析血管完全再通的影响因素。结果完全血管再通组发病至MRI检查时间、发病至开始取栓时间、发病至血管再通时间明显快于不全血管再通组(t=13.049,P=0.004;t=13.774,P=0.003;t=13.105,P=0.002)。与不全血管再通组相比,完全血管再通组DWI梗死体积更小(t=-2.520,P=0.014)、心房颤动(房颤)比例更低(χ2=10.070,P=0.002)、预后更好(t=-2.550,P=0.013)。Spearman等级相关分析显示发病至MRI检查时间、发病至开始取栓时间、发病至血管再通时间及DWI梗死体积与血管再通呈正相关(r=0.310,P=0.008;r=0.339,P=0.004;r=0.344,P=0.003;r=0.308,P=0.008);房颤与血管再通呈负相关(r=0.498,P=0.000);血管再通与预后呈正相关(r=0.293,P=0.013)。多元逻辑回归分析显示发病至血管再通时间(OR=1.376, 95%CI:1.027~1.844,P=0.033)、DWI梗死体积(OR=1.034, 95%CI:1.004~1.065,P=0.028)、房颤(OR=0.031, 95%CI:0.005~0.197,P=0.000)为预测卒中血管内血栓切除术后血管再通的独立预测因子。结论卒中血管内血栓切除术前评估发病至血管再通时间、DWI梗死体积及房颤史可有助于预测血管再通程度。
Objective To investigate the influencing factors of vascular recanalization after endovascular thrombectomy for acute stroke. Methods Seventy-two acute stroke patients who received endovascular thrombectomy in our hospital from January 2017 to December 2018 were collected prospectively. All patients underwent MRI examination before treatment. DWI infarction volume, revascularization [evaluating by modified thrombolysis in cerebral infarction(mTICI) score], functional outcome(mRS at 3 months) and other clinical data were collected. The parameters difference was compared between different revascularization group. Spearman grade correlation analysis and multiple Logistic regression analysis were performed to evaluate the influencing factors of revascularization after stroke. Results The time from onset to MRI examination, the time from onset to thrombectomy and the time from onset to recanalization in complete revascularization group were significantly faster than those in incomplete revascularization group(t=13.049, P=0.004;t=13.774, P=0.003;t=13.105, P=0.002). Compared with those in incomplete revascularization group, the DWI infarction volume(t=-2.520, P=0.014) in the complete revascularization group was smaller, the proportion of atrial fibrillation was lower(χ~2=10.070, P=0.002), and the outcome was better(t=-2.550, P=0.013). Spearman grade correlation analysis showed that the time from onset to MRI examination, the time from onset to thrombectomy, the time from onset to recanalization and the DWI infarction volume were positively correlated with recanalization(r=0.310, P=0.008;r=0.339, P=0.004;r=0.344, P=0.003;r=0.308, P=0.008), atrial fibrillation was negatively correlated with recanalization(r=0.498, P=0.000), recanalization was positively correlated with the outcome(r=0.293, P=0.013). Multiple Logistic regression analysis showed that the time from onset to revascularization(OR=1.376, 95%CI: 1.027-1.844, P=0.033), DWI infarction volume(OR=1.034, 95%CI: 1.004-1.065, P=0.028)and atrial fibrillation( OR = 0. 0
作者
黄红涛
邱建博
陈广浩
王薇
HUANG Hong-tao;QIU Jian-bo;CHEN Guang-hao(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《临床神经病学杂志》
CAS
2020年第5期367-370,共4页
Journal of Clinical Neurology
关键词
卒中
磁共振成像
扩散加权成像
血管再通
预后
stroke
magnetic resonance imaging
diffusion-weighted imaging
revascularization
prognosis
