床突旁动脉瘤血流导向装置置入术后发生缺血性卒中的危险因素分析  

Risk factor analysis of ischemic stroke following flow diverter placement for paraclinoid aneurysms

作　　者：田忠彬 吴欣志 李文强 朱巍 杨新健[1,2] 张义森[1,2] Tian Zhongbin;Wu Xinzhi;Li Wenqiang;Zhu Wei;Yang Xinjian;Zhang Yisen(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070、China;Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,100070 [2]首都医科大学附属北京天坛医院神经介入科,100070

出　　处：《中华神经外科杂志》2019年第9期895-899,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81801158);首都卫生发展科研专项(2018-4-1077)。

摘　　要：目的探讨影响床突旁动脉瘤Pipeline血流导向装置(PED)置入术后发生缺血性卒中的临床危险因素。方法回顾性分析首都医科大学附属北京天坛医院神经介入科2015年9月至2018年7月收治的205例床突旁动脉瘤患者的临床资料。术前对所有患者行数字减影血管造影(DSA)三维重建,测量动脉瘤的大小和载瘤动脉远、近端直径,选择合适尺寸的PED置入,必要时填入弹簧圈。术后观察患者是否出现缺血性卒中,进一步采用单因素和多因素logistic回归分析方法探讨影响患者术后发生脑缺血性事件的危险因素’结果205例患者共229个床突旁动脉瘤,均成功置入PED。其中,对110个动脉瘤单纯行PED置入术,对另119个行PED结合弹簧圈栓塞治疗。205例患者中,术后18例(8.8%)出现缺血性卒中,187例(91.2%)未出现。单因素分析结果显示,年龄、性别、合并原发性高血压、吸烟史、饮酒史、临床表现、花生四烯酸(AA)抑制率髙、颅内动脉瘤最大径及手术方式均不是患者术后发生缺血性卒中的影响因素(均P>0.05),而二磷酸腺昔(ADP)抑制率低、ADP诱导的血凝块最大振幅(MA-ADP)高、存在氯吡格雷抵抗、术中采用复杂手术技术及手术时间长是患者术后发生缺血性卒中的影响因素(均P<0.05)。进一步多因素logistic回归分析显示,存在氯吡格雷抵抗((用=6.161,95%CI:1.480?25.649,0.012)、术中采用复杂手术技术(OR=8.405,95%CI:1.437~49.146,P=0.018)及手术时间长(OR=1.011,95%CI:1.002~1.020,P=0.022)是患者术后发生缺血性卒中的独立危险因素。结论存在氯吡格雷抵抗、术中采用复杂的手术技术及过长的手术时间是床突旁动脉瘤PED置入术后发生缺血性卒中的独立危险因素。Objective To evaluate risk factors for acute ischemic stroke following treatment of paraclinoid aneurysms using flow diverters.Methods Between September 2015 and July 2018,205 consecutive patients with 229 paraclinoid aneurysms were treated with Pipeline embolization device(PED)at Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University.The aneuiysm size and parent artery size were measured.According to the length,proximal and distal diameter of the parent artery,appropriate size of PED was deployed with or without coiling.Various potential risk factors associated with acute ischemic stroke following PED treatment were documented.Univariate and multivariate logistic regression analyses were applied to identify risk factors.Results Among the 205 patients with 229 paraclinoid aneurysms,110 aneurysms were treated by PED and 119 aneurysms received PED with coiling,all PED were delivered and implanted successfully.Eighteen(8.8%)patients with 20 aneurysms had acute ischemic stroke after PED deployment.Univariate cinalysis suggested that ADP inhibition,high MA-ADP value,clopidogrel non-response,application of complex intraoperative techniques,and long operation time were associated with the acute ischemic stroke following PED treatment(all P<0.05).Further multivariate logistic regression analysis showed the clopidogrel non-response(OR=6.161,95%CI:1.480-25.649,P=0.012),application of complex intraoperative techniques(OR=8.405,95%CI:1.437一49.146,P=0.018)and operation time(OR=1.011,95%CI:1.002-1.020,P=0.022)were independent factors for acute ischemic stroke following PEI)treatment.Conclusions Clopidogrel non-response,application of complex intraoperative techniques and long operation time may increase the risk of ischemic events.

关 键 词：颅内动脉瘤 卒中 因素分析 统计学 血流导向装置 床突旁 

分 类 号：R74[医药卫生—神经病学与精神病学]