颅内动脉狭窄支架置入术围手术期安全性评估:富穿支动脉对比少穿支动脉  被引量:3

Perioperative safety assessment of stenting for intracranial artery stenosis: the group with rich perforator artery versus the group with few perforator artery

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作  者:罗国强 刘宇峰 张涛 赵振伟 邓剑平 Luo Guoqiang;Liu Yufeng;Zhang Tao;Zhao Zhenwei;Deng Jianping(Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University,Xi′an 710000,China)

机构地区:[1]空军军医大学第二附属医院神经外科,西安710000

出  处:《中国脑血管病杂志》2023年第3期150-158,共9页Chinese Journal of Cerebrovascular Diseases

基  金:陕西省重点研发计划项目(2021SF-093)。

摘  要:目的探讨颅内动脉粥样硬化性狭窄(ICAS)支架置入术后30 d内的卒中发生率,对比富穿支动脉与少穿支动脉患者之间临床资料的差异,分析穿支动脉对颅内动脉狭窄支架置入术安全性的影响。方法检索2017年1月至2021年12月空军军医大学第二附属医院神经外科血管病数据库,筛选符合入组条件的所有接受支架置入术治疗的症状性ICAS病例,收集患者人口学资料(性别、年龄)、危险因素、临床表现(脑梗死、短暂性脑缺血发作)、病变位置(基底动脉及大脑中动脉M1段为富穿支动脉,颈动脉及椎动脉颅内段为少穿支动脉)及影像学资料、手术相关信息以及术后30 d内出血和缺血事件。依据穿支动脉情况,将患者分为富穿支动脉组和少穿支动脉组,比较两组患者的临床资料。采用单因素Logistic回归分析和多因素Logistic回归分析,分析影响术后卒中发生的因素。结果共196例患者因ICAS接受支架置入术治疗。术后30 d内发生卒中12例(6.1%),其中出血性卒中6例(3.1%),缺血性卒中6例(3.1%)。富穿支动脉组96例,术后出血性卒中4例,缺血性卒中6例,卒中发生率10.4%;少穿支动脉组100例,术后出血性卒中2例,缺血性卒中0例,卒中发生率2.0%,富穿支动脉组围手术期卒中发生率明显高于少穿支动脉组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,穿支动脉(OR=6.01,95%CI:1.25~28.91,P=0.020)和吸烟(OR=0.18,95%CI:0.04~0.89,P=0.036)是术后发生卒中的独立影响因素,相对于少穿支动脉,富穿支动脉发生术后卒中的风险更高。结论ICAS支架置入术围手术期的卒中发生率在可接受范围,富穿支动脉的基底动脉和大脑中动脉M1段狭窄具有更高的围手术期卒中发生率,吸烟也是围手术期卒中发生的影响因素。Objective To investigate the rate of stroke within 30 days after intracranial atherosclerotic stenosis(ICAS)stenting and to determine the impact of perforator artery on the safety of intracranial artery angioplasty by comparing the difference between the group with rich and few perforator arteries.Methods The database of vascular diseases in Neurosurgery Department of the Second Affiliated Hospital of Air Force Medical University from January 2017 to December 2021 was retrospectively searched and all patients eligible for inclusion who received stenting for symptomatic intracranial arteriosclerosis were screened.Demographic data(gender,age),risk factors,clinical manifestations(cerebral infarction,transient ischemic attack),lesion location(basilar artery and M1 segment of middle cerebral artery as with rich perforator artery;intracranial segment of carotid artery and vertebral artery as with few perforator artery),imaging data,surgical information,and bleeding and ischemic events within 30 days after surgery were collected.According to the perforator artery condition,the patients were divided into rich perforator artery group and few perforator artery group,and the clinical data of the two groups were compared.Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to analyze the factors affecting the occurrence of postoperative stroke.Results From January 2017 to December 2021,a total of 196 patients in a single center received percutaneous transluminal angioplasty and stenting for symptomatic ICAS.There were 12(6.1%)cases of stroke within 30 days after surgery,including 6(3.1%)cases of hemorrhagic and 6(3.1%)cases of ischemic stroke.96 patients in the rich perforator artery group had postoperative hemorrhagic stroke in 4 cases and ischemic stroke in 6 cases,with an incidence of 10.4%.There were 100 cases in the few perforator artery group,with 2 cases of postoperative hemorrhagic and 0 case of ischemic stroke,and the incidence of stroke was 2.0%.The incidence of perioperat

关 键 词:动脉粥样硬化 颅内动脉狭窄 支架 穿支动脉 

分 类 号:R651.12[医药卫生—外科学]

 

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