急性颈内动脉末端闭塞分型及Willis环变异在机械取栓治疗预后判断中的应用  

Classifications of acute distal occlusion of internal carotid artery and variation of Willis' circle in predicting prognoses of acute ischemic stroke patients after mechanical thrombectomy

作　　者：吴文娟[1] 成月 蒋璟璇 蔡冬梅 张雷[1] Wu Wenjuan;Cheng Yue;Jiang Jingxuan;Cai Dongmei;Zhang Lei(Department of Radiology,Wuxi Second People's Hospital,Wuxi 214001,China;Department of Radiology,Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China;Department of Radiology,Wuxi Xishan People's Hospital,Wuxi 214105,China)

机构地区：[1]无锡市第二人民医院影像科,无锡214002 [2]上海交通大学附属上海六院影像科,上海200233 [3]无锡市锡山人民医院影像科,无锡214105

出　　处：《中华神经医学杂志》2022年第5期450-455,共6页Chinese Journal of Neuromedicine

基　　金：无锡市"双百"中青年医疗卫生拔尖人才培养计划。

摘　　要：目的探讨急性颈内动脉末端闭塞分型及Willis环变异情况在急性缺血性脑卒中患者机械取栓治疗后预后判断中的应用价值。方法回顾性分析无锡市第二人民医院、上海交通大学附属上海六院、无锡市锡山人民医院自2016年1月至2020年11月收治的158例急性缺血性脑卒中患者临床及影像学资料。所有患者均经影像学诊断为急性颈内动脉末端闭塞且行血管内机械取栓治疗。根据闭塞位置将颈内动脉末端闭塞分为Ia、Ib、L及T型4型。通过治疗90 d后患者改良Rankin量表(mRS)评分评价预后。采用多因素Logistic回归明确影响患者预后的独立因素。结果158例中预后良好组患者58例,预后不良组患者100例。与预后不良组患者比较,预后良好组患者年龄明显偏低,入院时美国国立卫生研究院卒中量表(NIHSS)评分明显偏低,房颤比例明显偏低,差异均有统计学意义(P<0.05)。2组患者颈动脉闭塞分型差异有统计学意义(P<0.05),预后良好组中Ia型患者比例最高,T型最低,分别为75.9%和3.4%。2组患者Wills环变异情况差异无统计学意义(P>0.05)。多因素Logistic回归结果显示房颤及颈内动脉末端闭塞分型为T型是影响预后的独立因素(OR=0.342,95%CI:0.127~0.919,P=0.033;OR=0.066,95%CI:0.005~0.803,P=0.033)。结论房颤及颈内动脉末端闭塞分型为T型患者更易出现不良预后。Objective To evaluate the application values of classifications of acute distal occlusion of internal carotid artery and variation of Willis'circle in predicting prognoses of acute ischemic stroke patients after mechanical thrombectomy(MT).Methods One hundred and fifty-eight patients with acute ischemic stroke,admitted to our hospital from January 2016 to November 2020,were chosen in our study;these patients had conformed imaging diagnosis of acute distal occlusion of internal carotid artery and accepted endovascular MT;the clinical and imaging data of these patients were retrospectively analyzed.The distal occlusion of internal carotid artery was divided into Ia,Ib,L,and T types according to the occlusion positions.Prognoses were evaluated by modified Rankin Scale(mRS)90 d after treatment.Multivariate Logistic regression was used to determine the independent factors for prognoses.Results Among these 158 patients,58 patients achieved good prognosis and 100 had poor prognosis.As compared with patients in the poor prognosis group,patients in the good prognosis group had significantly younger age,significantly lower NIHSS scores at admission,and statistically lower atrial fibrillation ratio(P<0.05).There were statistical differences in the classifications of acute distal occlusion of internal carotid artery between the two groups(P<0.05):the proportion of Ia type in patients of good prognosis group was the highest(75.9%),while that of T type was the lowest(3.4%).There was no significant difference in variation of Willis'circle between the two groups(P>0.05).Multivariate Logistic regression analysis showed that T type of acute distal occlusion of internal carotid artery and atrial fibrillation were independent factors for prognoses of these patients(OR=0.342,95%CI:0.127-0.919,P=0.033;OR=0.066,95%CI:0.005-0.803,P=0.033).Conclusion Patients with T type of acute distal occlusion of internal carotid artery and atrial fibrillation are trend to have poor prognosis.

关 键 词：颈内动脉末端闭塞 WILLIS环 机械取栓 CT血管成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]