机械血栓切除术后“成功”再通的前循环卒中患者的转归：TICI3与TICI2b比较  

Outcomes in patients with ＂successful＂ recanalizalion in anterior circulation stroke treated with mechanical thrombectomy： TICI 3 versus TICI 2b

作　　者：李凤利[1] 王金晶[1] 戴征[1] 彭锋[2] 肖露露[1] 孙文[1] 李敏[1] 刘新峰[1] 

机构地区：[1]南京大学附属金陵医院(南京军区南京总医院)神经内科,210002 [2]厦门大学附属中山医院神经内科,361000

出　　处：《国际脑血管病杂志》2017年第5期406-411,共6页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金（81530038,81501193）

摘　　要：目的探讨急性前循环卒中机械取栓后脑梗死溶栓（Thrombolysis in Cerebral Infarction，TICI）再通分级TICI2b与TICI3患者的转归差异。方法回顾性纳入机械血栓切除术后“成功”再通的急性前循环卒中患者，并分为TICI2b（几乎完全再通）组和TICI3（完全再通）组。转归良好定义为发病后3个月时改良Rankin量表评分0～2分。结果共纳入83例患者。T1CI2b级38例（45．8％），TICI3级45例（54．2％）；49例（59．0％）转归良好，34例（40．9％）转归不良。TICI3组转归良好率显著高于TICI2b组（68．9％对47．4％；x^2=3．946，P=0．047）。多变量logistic回归分析显示，校正年龄、高血压、糖尿病、基线收缩压、三酰甘油、静脉溶栓、ASITN／SIR侧支循环分级后，TICI3级是发病后3个月时转归良好的独立预测因素[优势比（oddsratio，OR）3．759，95％可信区间（confidence interval，ci）1．098～12．871；P=0．035]，而基线NIHSS评分较高（OR0．820，95％C10．715～0．941；P=0．005）和空腹血糖较高（OR0．610，95％C10．410～0．906；P=0．014）是发病后3个月时转归不良的独立预测因素。结论机械血栓切除术后“成功”再通的急性前循环缺血性卒中患者转归存在差异，TICI3的患者显著优于TICI2b的患者。Objective To investigate the difference in the outcomes in patients with acute anterior circulation stroke having achieved the Thrombolysis in Cerebral Infarction （TICI） 2b and TICI 3 recanalization after mechanical thrombectomy. Methods The patients with acute anterior circulation stroke having achieved ＂successful＂ recanalization after mechanical thrombeetomy were enrolled retrospeetively. They were divided into TICI 2b （＂almost complete＂ recanalization） group and TICI 3 （＂complete＂ recanalization） group. The good outcome was defined as the modified Rankin Scale score 0-2 at 3 months after onset. Results A total of 83 patients were enrolled in the study, including 38 patients （45.8%） with TICI 2b and 45 （54. 2%） with TICI 3; 49 （59.0%） had good outcome, and 34 （40.9%） had poor outcome. The good outcome rate in the TICI 3 group was significantly higher than that in the TIC] 2b group （68. 9% vs. 47. 4% ;X2 =3. 946, P =0. 047）. After adjusting for age, hypertension, diabetes, baseline systolic blood pressure, triglyceride, intravenous thrombolysis, and ASITN/SIR collateral grades, TICI 3 was an independent predictor for good outcome at 3 months after onset （odds ratio [ OR] 3.759, 95% confidence interval [ CI] 1. 098-12. 871; P = 0. 035）, while the higher baseline National Institutes of Health Stroke Scale score （OR O. 820, 95% CI O. 715-0. 941; P=0. 005） and higher fasting glucose （OR O. 610, 95% CI O. 410-0. 906; P = 0. 014） were the independent predictors for poor outcome at 3 months after onset. Conelusiom There are difference in the outcomes in patients with ＂successful＂ recanalization in anterior circulation stroke treated with mechanical thrombectomy. The outcome is substantially better in TICI 3 than TICI 2b patients.

关 键 词：卒中 脑缺血 血栓切除术 血管内手术 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]