多模式CT指导下机械取栓治疗心源性栓塞所致急性前循环脑梗死疗效分析  

Clinical analysis of multi-mode CT-guided mechanical thrombectomy in the treatment of acute anterior circulation cerebral infarction caused by cardiogenic embolism

作　　者：罗雅尹 赵满红 李迪[2] 韩杰[1] 陈忠军[2] LUO Yayin;ZHAO Manhong;LI Di(Department of Neurology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院神经内科,辽宁大连116011 [2]大连市中心医院神经介入及神经重症科,辽宁大连116000

出　　处：《中风与神经疾病杂志》2023年第2期147-150,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的评价多模式CT评估指导下机械取栓治疗心源性栓塞所致急性前循环脑梗死疗效。方法回顾性分析经机械取栓治疗的心源性栓塞所致急性前循环脑梗死患者基线及随访资料,依据术前评估方式分为多模式CT组(multimode computed tomography,MMCT)和非增强CT组(non-contrast computed tomography,NCCT)。通过对比两组患者的血管再通率、NIHSS评分、3个月改良Rankin量表(mRS)评分来分析其疗效,通过对比症状性出血转化风险和死亡率等分析其安全性。采用多因素Logistic回归分析影响患者预后的因素。结果纳入分析118例,MMCT组58例、NCCT组60例,两组术后3个月功能独立的患者比例差异具有统计学意义(58.9%vs 31.7%,P=0.034),症状性颅内出血转化及死亡率差异无统计学意义(P>0.05)。多因素回归分析显示是否行多模式CT评估筛选及基线NIHSS评分是影响预后的独立因素。结论多模式CT评估指导下机械取栓治疗心源性栓塞所致急性前循环脑梗死能带来更好的临床预后,基线NIHSS评分与机械取栓治疗心源性栓塞所致急性前循环脑梗死患者预后密切相关,未来仍需开展研究进一步验证上述结论。Objective To evaluate the efficacy of mechanical thrombectomy under the guidance of multi-mode computed tomography in the treatment of acute anterior circulation cerebral infarction caused by cardiogenic embolism.Methods We retrospectively analyzed the baseline and follow-up data of patients with cardiogenic acute anterior circulation ischemic stroke treated with mechanical thrombolectomy.According to the preoperative evaluation,the patients were divided into MMCT group and NCCT group.The efficacy was analyzed by comparing the vascular revascularization rate,NIHSS score and 3-month Modified Rankin Scale(mRS)score of the two groups,and the safety was analyzed by comparing the conversion risk and mortality of symptomatic bleeding.Multivariate logistic regression was used to analyze the factors affecting the prognosis of patients.Results A total of 118 eligible patients were finally included,including 58 in MMCT group and 60 in NCCT group.There was no significant difference in the proportion of functionally independent patients between the two groups 3 months after surgery(58.9%vs 31.7%P=0.034),and no significant difference in symptomatic intracranial hemorrhage transformation and mortality(P>0.05).Multivariate regression analysis showed that MMCT and baseline NIHSS score were independent prognostic factors.Conclusion Mechanical thrombectomy under the guidance of multi-mode CT evaluation does bring better clinical prognosis for patients with acute anterior circulation cerebral infarction caused by cardiac embolism.MMCT and baseline NIHSS score are closely related to the prognosis of patients with acute anterior circulation cerebral infarction caused by cardiac embolism.Future studies are needed to further verify the above conclusions.

关 键 词：缺血性脑卒中 心源性栓塞 多模式CT 机械取栓 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]