大动脉粥样硬化型与心源性栓塞型急性基底动脉闭塞血管内治疗的临床疗效比较  

Comparison of clinical efficacies of endovascular treatments in patients with acute basilar artery occlusion caused by large-artery atherosclerosis and cardioembolism

作　　者：潘晓虎 朱发勇 刘亚 王发胜 曹月洲[2] 贾振宇[2] 赵林波[2] 刘圣[2] Pan Xiaohu;Zhu Fayong;Liu Ya;Wang Fasheng;Cao Yuezhou;Jia Zhenyu;Zhao Linbo;Liu Sheng(Department of Neurology,Xuyi County People's Hospital of Huaian City,Huaian 211700,China;Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]淮安市盱眙县人民医院神经内科,淮安211700 [2]南京医科大学第一附属医院介入放射科,南京210029

出　　处：《中华神经医学杂志》2022年第11期1097-1103,共7页Chinese Journal of Neuromedicine

摘　　要：目的对比大动脉粥样硬化(LAA)型与心源性栓塞(CE)型急性基底动脉闭塞(ABAO)血管内治疗的临床疗效差异。方法选择自2018年3月至2022年2月于南京医科大学第一附属医院介入放射科和盱眙县人民医院神经内科行血管内治疗的104例ABAO患者为研究对象,其TOAST病因学分型为LAA型或CE型,比较LAA型与CE型患者间一般资料、手术信息及临床疗效等方面的差异,并采用单因素及多因素Logistic回归分析明确预后不良的影响因素。结果104例患者中LAA型组51例(49.0%),CE型组53例(51.0%);96例(92.3%)的闭塞血管成功再通,35例(33.7%)术后90 d预后良好(改良Rankin量表评分0~2分)。与CE型组患者相比,LAA型组患者的心房颤动史比例更低、基线美国国立卫生研究院卒中量表(NIHSS)评分更低、基底动脉中下段闭塞比例更高、手术时间更长、术中行补救性支架成形术比例更高,差异均有统计学意义(P<0.05),但2组患者间血管成功再通比例、症状性颅内出血发生率及术后90 d预后方面的差异均无统计学意义(P>0.05)。年龄(OR=0.935,95%CI:0.891~0.981,P=0.006)、基于CTA原始图像的基底动脉闭塞半定量评分(OR=1.520,95%CI:1.180~1.959,P=0.001)是ABAO血管内治疗预后不良的独立影响因素,而TOAST病因学分型(LAA/CE型)不是预后不良的独立影响因素(OR=1.175,95%CI:0.461~2.933,P=0.736)。结论LAA型与CE型ABAO在发病危险因素、病情严重程度、血管闭塞部位、血管内治疗方式及手术时间等方面存在差异,但临床疗效无明显差异,且脑卒中病因与预后无显著关联。Objective To compare the clinical efficacies of endovascular treatments in patients with acute basilar artery occlusion(ABAO)caused by large-artery atherosclerosis(LAA)and cardioembolism(CE).Methods From March 2018 to February 2021,104 patients with ABAO accepted endovascular treatments in Department of Neurology and Department of Interventional Radiology,Xuyi County People's Hospital of Huaian City were enrolled;these patients were classified into either a LAA group or a CE group according to Trial of ORG 10172 in Acute Stroke Treatment classification(TOAST).The differences in general data,procedure information,and clinical efficacies were compared between the 2 groups.Univariate and multivariate Logistic regression analyses were used to identify the influencing factors for poor prognosis.Results In these 104 patients,51 patients(49.0%)were into the LAA group and 53 patients(51.0%)into the CE group.Ninety-six patients(92.3%)acquired successful revascularization,and 35 patients(33.7%)had good prognosis(modified Rankin scale scores of 0-2)90 d after surgery.LAA group had significantly lower percentage of patients with atrial fibrillation,significantly lower baseline National Institutes of Health Stroke Scale scores,statistically higher percentages of patients with lower and middle basilar artery occlusion and patients accepted rescued stenting,and statistically longer procedure time(P<0.05).There were no significant differences between the two groups in terms of successful recanalization percentage,symptomatic intracranial hemorrhage incidence,and prognosis 90 d after surgery(P>0.05).Age(OR=0.935,95%CI:0.891-0.981,P=0.006)and semiquantitative scores of basilar artery based on computed tomography angiography(OR=1.520,95%CI:1.180-1.959,P=0.001)were independent influencing factors for poor prognosis.TOAST etiology(LAA/CE)was not an independent influencing factors for poor prognosis(OR=1.175,95%CI:0.461-2.933,P=0.736).Conclusion There are differences in risk factors,vascular occlusion sites,endovascular treatment,and

关 键 词：急性基底动脉闭塞 心源性栓塞型 大动脉粥样硬化型 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]