血管内治疗对不同病变性质急性基底动脉闭塞患者预后的影响  

Effect of intravascular therapy on prognosis of patients with acute basilar artery occlusion caused by different pathological properties

作　　者：陈科春 吴秋义[1] 周寅 张雯君 肖国栋[2] 刘慧慧[2] CHEN Kechun;WU Qiuyi;ZHOU Yin;ZHANG Wenjun;XIAO Guodong;LIU Huihui(Zhangjiagang Hospital of Soochow University,Zhangjiagang 215600,China;The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属张家港医院,江苏张家港215600 [2]苏州大学附属第二医院,江苏苏州215004

出　　处：《中国实用神经疾病杂志》2022年第8期929-934,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的评估血管内治疗对不同病变性质导致的急性基底动脉闭塞性脑卒中患者预后的影响。方法连续回顾性分析2017-11—2021-11在苏州大学附属张家港医院(31例)和苏州大学附属第二医院(50例)行血管内治疗的急性基底动脉闭塞患者81例,按照有无基底动脉狭窄(BAS)分BAS组和无BAS组,比较2组患者的临床、影像、手术资料,对比分析2组的预后结局。对BAS组进一步按血管成形术分亚组,比较预后。结果共纳入BAS组患者56例,无BAS组患者25例,其女性比例更高(48.0%vs 19.6%,P=0.009),BAS组的高血脂比例(25%vs 0,P=0.004)、吸烟比例(53.6%vs 24.0%,P=0.013)、入院低密度脂蛋白[2.96(2.60~3.59)vs 2.62(1.91~2.75),P=0.006]更高,BAS组患者pc-ASPECTS评分低于无BAS组患者[7(6~8)vs 8(7~8),P=0.01],采用血管内成形术BAS组更高(33.9%vs 8.0%,P=0.014)。2组的成功再灌注mTICI 2b~3、病变血管部位、穿刺-复流时间、rt-PA静脉溶栓率差异均无统计学意义(P>0.05)。经校正性别、年龄、吸烟、pc-ASPECTS、低密度脂蛋白、术后mTICI 2b~3比例等因素后,BAS组相比无BAS组,90 d良好预后mRS(0~2)更低(OR=0.20,95%CI:0.40~0.96,P=0.044),90 d有利预后mRS(0~3)、症状性颅内出血、90 d内死亡2组无统计学差异(P>0.05)。BAS组内有无血管成形术亚组比较,90 d良好预后、症状性颅内出血、死亡无统计学差异。结论急性基底动脉闭塞患者中BAS和无BAS组的血管内治疗再通率、手术时间无统计学差异,但合并BAS患者的90 d良好预后低于无BAS患者,而症状性颅内出血及死亡两者无显著差异。BAS患者中是否行血管内成形术对预后无影响。Objective To evaluate the effect of intravascular therapy on the prognosis of patients with acute basilar artery occlusion stroke caused by different pathological properties.Methods Totally 81 patients with acute basilar artery occlusion who underwent endovascular treatment in Zhangjiagang Hospital of Soochow University(31 cases)and the Second Affiliated Hospital of Soochow University(50 cases)from November 2017 to November 2021 were analyzed retrospectively.The patients were divided into BAS group and non BAS group ac⁃cording to whether there was basilar artery stenosis(BAS).The clinical,imaging and surgical data of the two groups were compared,and the prognosis and outcome of the two groups were compared and analyzed.Bas group was further divided into subgroups according to angioplasty,and the prognosis was compared.Results A total of 56 pa⁃tients with BAS and 25 patients with non BAS were included.The proportion of women in the non BAS group was higher(48.0%vs 19.6%,P=0.009).The proportion of hyperlipidemia(25%vs 0,P=0.004)and smoking(53.6%vs 24.0%,P=0.013)in BAS group were higher.The admission low-density lipoprotein in BAS group was higher than that in non BAS patients[2.96(2.60-3.59)vs 2.62(1.91-2.75),P=0.006],and the pc-ASPECTS was lower than that in non BAS patients[7(6-8)vs 8(7-8),P=0.01].Patients with BAS who underwent endovascular angioplasty were higher than those with non BAS(33.9%vs 8.0%,P=0.014).There was no significant difference in successful reperfusion mTICI 2b-3,lesion vessel location,puncture reflow time and intravenous thrombolysis rate of rt-PA between the two groups(P>0.05).After adjusting for gender,age,smoking,pc-ASPECTS,low density lipoprotein and postoperative mTICI 2b-3.Compared with non BAS group,the 90 day good prognosis mRS(0-2)in BAS group was lower,OR=0.20,95%CI:0.40-0.96,P=0.044.There was no significant difference in 90 day favorable prognosis mRS(0-3),symptomatic intra⁃cranial hemorrhage and death within 90 days between the two groups(P>0.05).There was no significant diff

关 键 词：急性基底动脉闭塞 血管内治疗 基底动脉狭窄 血管成形 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]