摘要
目的:探讨大动脉粥样硬化(LAA)与心源性栓塞(CE)2种不同机制所致急性大血管闭塞(ALVO)患者的临床特点,并比较血管内治疗(EVT)的疗效及预后。方法:回顾性纳入2018年5月至2022年7月在航天中心医院国家高级卒中中心接受EVT的ALVO患者。根据卒中病因分型将患者分为LAA组和CE组,应用mTICI分级评价血管再通情况、改良Rankin量表评分(m RS)评价患者90 d预后,统计术后72 h颅内出血转化(HT)发生率及90 d死亡率,评价EVT的安全性。比较2组患者的临床特征、手术疗效及预后,并探讨不良预后的独立危险因素。结果:共纳入184例患者,其中LAA组164例(89.1%),CE组20例(10.9%)。与CE组相比,LAA组年龄更小(P<0.001),基线美国国立卫生研究院卒中量表(NIHSS)评分更低(P=0.024),基线格拉斯哥昏迷(GCS)评分更高(P=0.037)。2组既往心房颤动(P<0.001)、饮酒史(P=0.004)及D-二聚体(P=0.008)及尿酸(P=0.038)水平均存在统计学差异。2组在穿刺至再通时间、术后成功再通、取栓次数及取栓方式等手术相关操作均无统计学差异。LAA组患者90 d预后良好的比例显著高于CE组(38.4%vs 10%,P=0.012),死亡率较CE组低(13.4%vs 35%,P=0.03),差异有统计学意义,但2组颅内HT无统计学差异(P=0.522)。多因素Logistic回归分析显示,年龄和基线NIHSS评分是不良预后的独立危险因素。结论:LAA型缺血性卒中患者接受EVT治疗较CE型预后更好、死亡率更低;年龄、基线NIHSS评分与不良预后独立相关。
Objective:To discuss the differences in clinical characteristics of patients with acute large vessel occlusion(ALVO)due to large artery atherosclerosis(LAA)or cardioembolism(CE),and to compare the effica-cy of endovascular treatment(EVT).Methods:All patients with ALVO who received EVT between May 2018 and July 2022 in the Aerospace Center Hospital National Advanced Stroke Center were included in this retro-spective study.Patients were classified into the LAA group and CE group according to the TOAST classification system.Modified Thrombolysis in Cerebral Infarction(mTICI)score was used to evaluate the revascularization status;modified Rankin Scale score(mRS)at 90-day was used to evaluate prognosis;intracranial hemorrhage transformation(HT)within 72 hours after EVT and 90-day mortality were used to evaluate the safety of the sur-gery.We compared the clinical characteristics,therapeutic efficacy,and the prognosis of two groups after EVT,and explored the independent risk factors for poor prognosis.Results:A total of 184 patients were enrolled in this study;164 patients were placed in the LAA group(89.1%)and 20 in the CE group(10.9%).Compared to pa-tients in the CE group,those in the LAA group had a significantly younger age(P<0.001),lower baseline Nation-al Institutes of Health Stroke Scale(NIHSS)scores(P=0.024),and higher Glasgow coma scale(GCS)scores(P=0.037).There were statistically significant differences in history of atrial fibrillation(P<0.001),drinking(P=0.004),D-dimer level(P=0.008),and uric acid level(P=0.038).There were no significant differences in puncture to reperfusion time,re-canalization rate,times of thrombectomy and thrombectomy method.Compared to patients in the CE group,those in the LAA group had a significantly higher good prognosis rate(38.4%vs.10%,P=0.012),lower mortality rate(13.4%vs.35%,P=0.03),but there was no signifi-cant difference in intracranial HT(P=0.522).Multivariate logistic regression analysis showed that age and baseline NIHSS scores were in-dependent risk factors for poor progno
作者
赵静
石翀
吴群
万志荣
罗彬
姚昕璐
徐亚辉
王培福
李继来
ZHAO Jing;SHI Chong;WU Qun;WAN Zhi-rong;LUO Bin;YAO Xin-lu;XU Ya-hui;WANG Pei-fu;LI Ji-lai(Department of Neurology,Aerospace Center Hospital,Beijing 100049,China;Department of Traditional Chinese medicine,Aerospace Center Hospital,Beijing 100049,China)
出处
《神经损伤与功能重建》
2023年第6期329-333,366,共6页
Neural Injury and Functional Reconstruction
关键词
急性大血管闭塞
大动脉粥样硬化
心源性栓塞
血管内治疗
large vessel occlusion
large artery atherosclerosis
cardioembolism
endovascular treatment
