机械取栓术治疗急性缺血性脑卒中伴恶性肿瘤患者效果分析  

Mechanical thrombectomy for acute ischemic stroke in patients with a current or previous malignancy:analysis of its curative effect

作　　者：侯凯文 李沛城[1] 陈珑[1] 李波[1] 刘一之[1] 袁晨 陈正文 杨绪森 HOU Kaiwen;LI Peicheng;CHEN Long;LI Bo;LIU Yizhi;YUAN Chen;CHEN Zhengwen;YANG Xusen(Deparment of Interenional Radiology The First Aflialed Hospial of Soochow University,Suzhou,Jiangsu Province 215006,China)

机构地区：[1]苏州大学附属第一医院介入科,江苏215006

出　　处：《介入放射学杂志》2022年第9期852-856,共5页Journal of Interventional Radiology

摘　　要：目的 评价前循环急性缺血性脑卒中(AIS)伴恶性肿瘤患者接受机械取栓治疗的有效性和安全性,分析影响机械取栓术预后的因素。方法 回顾性分析2016年6月至2021年9月在苏州大学附属第一医院接受机械取栓治疗的前循环AIS患者临床资料。根据患者病史分为肿瘤组与非肿瘤组。评估两组患者基线资料、取栓术后症状性颅内出血发生率和90 d改良Rankin量表(mRS)评分等指标。再将肿瘤组患者分为预后良好(术后90 d mRS评分≤2分)和预后不良(mRS评分>2分)。采用单因素和多因素logistic分析影响AIS伴恶性肿瘤患者机械取栓治疗预后的因素。结果 共入组219例患者(肿瘤组24例,非肿瘤组195例)。肿瘤组、非肿瘤组分别成功复流23例(95.8%)、183例(93.8%),差异无统计学意义(P=1.00);术后出血转化率(52.2%比41.5%,P=0.331)、症状性颅内出血发生率(17.4%比12.0%,P=0.503)、90 d预后良好率(39.1%比42.1%,P=0.787)差异均无统计学意义。logistic回归分析显示,静脉溶栓后桥接机械取栓治疗是肿瘤组患者术后90 d临床预后不良的影响因素。与非肿瘤组相比,肿瘤组桥接治疗后有更高的症状性颅内出血发生率(36.4%比10.9%,P=0.044)。结论 机械取栓治疗前循环AIS伴恶性肿瘤患者安全、有效。直接机械取栓治疗AIS伴恶性肿瘤患者比桥接治疗有更低的症状性颅内出血发生率和更好的预后。Objective To evaluate the effectiveness and safety of mechanical thrombectomy(MT) in treating patients with anterior circulation acute ischemic stroke(AIS) who has a current or previous malignancy,and to analyze the factors affecting the patient’s prognosis after MT. Methods The clinical data of patients with anterior circulation AIS, who received MT at the First Affiliated Hospital of Soochow University of China between June 2016 and September 2021, were retrospectively analyzed. According to their medical history,the patients were divided into the tumor group and the non-tumor group. The clinical baseline data, the incidence of symptomatic intracranial hemorrhage after MT, and the 90-day modified Rankin scale(mRS)score of the two groups were assessed. Based on the 90-day mRS score, the patients of the tumor group were subdivided into good prognosis subgroup(mRS≤2 points) and poor prognosis subgroup(mRS>2 points).Univariate analysis and multivariate logistic analysis were used to analyze the factors affecting the prognosis of patients with malignancy after receiving MT. Results A total of 219 patients, including 24 of tumor group and195 of non-tumor group, were enrolled in this study. Successful reperfusion was achieved in 23 patients(95.8%) of tumor group and in 183 patients(93.8%) of non-tumor group, the difference between the two groups was not statistically significant(P=1.00). In the tumor group and non-tumor group, the postoperative blood transformation rates were 52.2% and 41.5% respectively(P=0.331), the incidences of symptomatic intracranial hemorrhage were 17.4% and 12.0% respectively(P=0.503), and the 90-day good prognosis rates were 39.1% and42.1% respectively(P=0.787). The differences in all the above indexes between the two groups were not statistically significant(all P>0.05). Logistic regression analysis showed that venous thrombolysis followed by MT, regarded as bridging-connection therapy, was an influencing factor for 90-day poor clinical prognosis in patients of tumor group. Compared with

关 键 词：机械取栓 恶性肿瘤 急性缺血性脑卒中 桥接治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]