颅内动脉粥样硬化性病变或栓塞对急性缺血性卒中机械取栓患者预后的影响  

Effect of intracranial atherosclerotic disease and embolism on prognosis in acute ischemic stroke patients treated with mechanical thrombectomy

作　　者：李娜[1,2] 吉训明[3] Li Na;Ji Xunming(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]北京市仁和医院老年科,102600 [3]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2022年第6期368-375,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：教育部长江学者奖励计划(T2014251);十三五国家重点研发计划(2016YFC1301502)。

摘　　要：目的 比较颅内动脉粥样硬化性病变或栓塞所致的急性缺血性卒中患者接受机械取栓治疗的效果,探索两者对患者预后的影响。方法 回顾性连续纳入2012年12月至2018年12月于首都医科大学宣武医院接受机械取栓治疗的前循环急性缺血性卒中患者。依据病因为颅内动脉粥样硬化性病变或栓塞,将所有患者分为颅内动脉粥样硬化组及栓塞组,对两组患者的临床预后[术后3个月改良Rankin量表(mRS)评分0~2分为功能独立]进行比较,并应用多因素Logistic回归分析探索颅内动脉粥样硬化性病变和栓塞与临床结局的相关性。结果 共纳入306例患者,其中颅内动脉粥样硬化组209例,栓塞组97例。134例(43.8%)患者在术后3个月实现功能独立,颅内动脉粥样硬化组与栓塞组间功能独立患者比例差异无统计学意义[46.4%(97/209)比38.1%(37/97),P=0.175]。多因素Logistic回归分析结果表明,不同病因与患者术后3个月的功能独立无显著相关性(OR=1.385,95%CI:0.378~5.073;P=0.623)。结论 对于前循环大血管闭塞接受机械取栓治疗的急性缺血性卒中患者,颅内动脉粥样硬化性病变或栓塞对神经功能结局并无显著影响。未来仍需开展研究进一步验证上述结论。Objective To compare the efficacy and safety of mechanical thrombectomy in acute ischemic stroke patients with intracranial atherosclerotic disease or embolism,and to explore the influence of them on the prognosis of these patients.Methods Acute ischemic stroke patients in anterior circulation who received mechanical thrombectomy in Xuanwu Hospital,Capital Medical University from December 2012 to December 2018 were consecutively enrolled.Patients were divided into intracranial atherosclerotic disease group and embolic group according to the corresponding etiology.The functional outcomes(the modified Rankin scale [mRS] score of 0-2 at 3 months after operation was defined as functional independence) was compared,and the association between the intracranial atherosclerotic disease,embolism and prognosis was explored using multivariable Logistic regression analysis.Results Among the 306 patients enrolled,209 patients were in the intracranial atherosclerotic disease group and 97 patients were assigned to the embolic group.One hundred thirty-four patients(43.8%) achieved functional independence 3 months after procedure,with no statistically significant difference between the two groups(46.4% [97/209] vs.38.1%[37/97],P=0.175).Multivariable Logistic regression analysis showed that there was no significant association between the intracranial atherosclerotic disease,embolism and functional independence 3 months after procedure(OR,1.385,95% CI 0.378-5.073;P=0.623).Conclusions For acute ischemic stroke patients in anterior circulation receiving mechanical thrombectomy,the intracranial atherosclerotic disease or the embolism has no significant effect on neurological outcome.Further studies are needed to confirm these conclusions.

关 键 词：缺血性卒中 颅内动脉粥样硬化 栓塞 机械取栓 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]