急性大血管闭塞性卒中机械取栓术中血栓逃逸与预后的关系  

The relationship between periprocedural thrombus migration and clinical outcomes in patients with acute large vessel occlusion after mechanical thrombectomy

作　　者：陈楚 张汤钦 许友清 袁莉莉 许向军 杨科 杨倩[1] 黄显军[1] 周志明[1] Chen Chu;Zhang Tangqin;Xu Youqing;Yuan Lili;Xu Xiangjun;Yang Ke;Yang Qian;Huang Xianjun;Zhou Zhiming(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,芜湖241001

出　　处：《中华神经科杂志》2021年第10期1025-1032,共8页Chinese Journal of Neurology

摘　　要：目的探讨血栓逃逸发生的早期预测因素及血栓逃逸与卒中患者机械取栓术(MT)后预后的关系。方法回顾性分析2015年5月至2019年12月在皖南医学院弋矶山医院卒中中心行MT的前循环急性大血管闭塞性卒中患者。收集入组患者的基线数据、手术参数及90 d预后等数据。采用单、多因素回归分析探讨引起血栓逃逸的危险因素以及血栓逃逸与患者预后的关系。结果本次入组急性大血管闭塞性卒中患者302例,年龄(68.8±11.0)岁,男性166例(占55.0%)。共有80例(26.5%)发生血栓逃逸,其中60例为血栓近端逃逸,占总逃逸数量的75.0%。心源性卒中(心源性与大动脉粥样硬化型OR=2.722,95%CI 1.367~5.418,P=0.004)和血栓负荷指数(OR=0.849,95%CI 0.745~0.968,P=0.015)是发生血栓逃逸的独立危险因素。近端血栓逃逸(近端血栓逃逸比无血栓逃逸OR=2.822,95%CI 1.220~6.528,P=0.015)是患者90 d预后的独立危险因素;而远端血栓逃逸对90 d预后的影响差异无统计学意义。结论在接受MT治疗的急性大血管闭塞性卒中患者中,心源性卒中及血栓负荷指数评分较低是发生血栓逃逸的独立预测因素。近端血栓逃逸是患者预后的独立危险因素,具有重要的临床干预意义。Objective To investigate the early predictive factors of periprocedural thrombus migration and the relationship between periprocedural thrombus migration and prognosis after mechanical thrombectomy(MT)in stroke patients.Methods The patients with anterior circulation acute large vessel occlusion stroke(ALVOS)who underwent MT in the Stroke Center of Yijishan Hospital of Wannan Medical College from May 2015 to December 2019 were retrospectively analyzed.The baseline characteristics,procedural and clinical outcomes were collected.Univariate and multivariate regression analysis was used to explore the risk factors of thrombus migration and the relationship between thrombus migration and prognosis of patients.Results There were 302 ALVOS patients[(68.8±11.0)years old and 166 males(55.0%)]included,of whom thrombus migration was identified in 80 patients(26.5%),including 60 cases(75.0%)of proximal migration.Cardiogenic stroke(OR=2.722,95%CI 1.367-5.418,P=0.004)and clot burden score(CBS;OR=0.849,95%CI 0.745-0.968,P=0.015)were independent risk factors of thrombus migration.Proximal migration(OR=2.822,95%CI 1.220-6.528,P=0.015)was an independent risk factor of 90-day clinical outcome,while the effect of distal migration on 90-day clinical outcome was not statistically significant.Conclusions Cardiogenic stroke and lower CBS score are independent predictors of periprocedural thrombus migration in ALVOS patients who underwent MT.Proximal migration is an independent risk factor for the prognosis of patients,which has important clinical intervention significance.

关 键 词：血栓栓塞 卒中 危险因素 预后 机械取栓术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]