基于脑血管造影影像学特征评估影响急诊脑动脉内取栓术后结局的因素  

Evaluation of factors affecting the outcome of emergency cerebral arterial thrombectomy based on cerebral angiography imaging features

作　　者：朱存良 李长茂[1] 谢宁[1] 谭若利[1] 张臻[1] 洪早云[2] 张瑛瑛[1] 赵子攀[1] 易芳芳 Zhu Cunliang;Li Changmao;Xie Ning;Tan Ruoli;Zhang Zhen;Hong Zaoyun;Zhang Yingying;Zhao Zipan;Yi Fangfang(Department of Neurology,Loudi Central Hospital,Loudi 417000,China;Department of Medical Imaging,Loudi Central Hospital,Loudi 417000,China)

机构地区：[1]娄底市中心医院神内科,娄底417000 [2]娄底市中心医院医学影像科,娄底417000

出　　处：《中国医师进修杂志》2023年第2期102-107,共6页Chinese Journal of Postgraduates of Medicine

基　　金：湖南省科技创新计划项目 (2020SK51602)。

摘　　要：目的:基于脑血管造影影像学特征分析急诊脑动脉内取栓术后结局不良的预示因素。方法:回顾性总结将2017年1月至2022年2月娄底市中心医院接受血管内治疗的急性缺血性卒中(AIS)患者146例纳入研究对象,对患者行数字减影血管造影(DSA)检测,根据术后3个月改良Rankin量表将患者分为结局良好组(95例)与结局不良组(51例),比较两组间性别、年龄、发病至就诊时间、发病至腹股沟穿刺时间、静脉溶栓比例、闭塞部位、治疗策略、美国国立卫生研究院卒中量表(NIHSS)评分、核心梗死体积、缺血低灌注体积、侧支循环分级以及静脉引流状态评分;Logistic回归分析预示患者结局不良的危险因素;受试者工作特征曲线分析侧支循环分级、静脉引流状态评分对患者结局不良的预测价值,比较不同侧支循环分级、静脉引流状态组间一般资料以及影像学资料的差异。结果:与结局良好组比较,结局不良组患者发病至就诊时间、NIHSS评分、核心梗死体积、缺血低灌注体积、单纯抽吸取栓占比、侧支循环分级[2(2,3)级比2(1,2)级]和静脉引流评分[5(4,6)分比6(6,8)分]升高,差异有统计学意义(P<0.05),再通分级2b/3级占比降低(P<0.05);NIHSS评分、侧支循环分级和静脉引流状态是机械取栓术后3个月内结局不良的预示因素(OR=2.51、1.93、2.61,P<0.05);侧支循环分级与静脉引流评分预测AIS患者机械取栓后结局不良的曲线下面积分别为0.714和0.829;侧支循环不良、中等、良好AIS患者间发病至就诊时间(236.95±21.03 min、(250.41±21.32)min、(255.72±20.98 min)]、核心梗死体积[52(17,80)ml、25(15.5,30)ml、15(10,25)ml]和静脉引流评分[5(4,6)分、5(5,8)分、5(5,8)分]比较差异有统计学意义(P<0.05);静脉引流不良、中等、良好AIS患者发病至就诊时间(234.81±21.22)min、(256.83±20.88)min、(258.97±21.35)min)、核心梗死体积[17(13,45)ml、26(25,29)ml、20(11,29)ml]�Objective To analyze the predictors of poor outcomes after emergency intracerebral thrombectomy based on the characteristics of cerebral angiography.Methods A total of 146 patients with acute ischemic stroke(AIS)who received endovascular treatment in Loudi Central Hospital from March 2019 to February 2022 were included in the study,and digital subtraction angiography(DSA)was performed on the patients.The patients were divided into a good prognosis group(95 cases)and a poor prognosis group(51 cases)by the modified Rankin scale 3 months after operation.Gender,age,time from onset to visit,time from onset to puncture,proportion of intravenous thrombolysis,occlusion site,treatment strategy,National Institute of Health Stroke Scale(NIHSS)score,core infarct volume,ischemic hypoperfusion volume,collateral circulation classification,and venous drainage status were compared between the two groups score;Logistic regression was used to analyze the risk factors affecting the poor prognosis of patients;Receive Operating Characteristic(ROC)curve was used to analyze the predictive value of collateral circulation classification and venous drainage status score for poor prognosis of patients,and the differences in general data and imaging data were compared between groups with different collateral circulation grades and venous drainage status.Results Compared with the good outcome group,the time from onset to visit,NIHSS score,core infarct volume,ischemic hypoperfusion volume,the proportion of thrombectomy alone,and collateral circulation classification in the poor outcome group[2(2,3)levels.2(1,2)level]and venous drainage score[5(4,6)points vs.6(6,8)points]increased(P<0.05),and the proportion of recanalization grade 2b/3 decreased(P<0.05);NIHSS score,collateral circulation grade and venous drainage status were predictors of poor outcome within 3 months after mechanical thrombectomy(OR=2.51,1.93,2.61,P<0.05);collateral circulation grade and venous drainage score predicted mechanical thrombectomy in patients with AIS,the area under

关 键 词：脑血管造影术 脑动脉 侧支循环 静脉引流状态 

分 类 号：R651.11[医药卫生—外科学]