不同病因型急性前循环大血管闭塞性缺血性卒中患者机械取栓术后定量数字减影血管造影参数的预后预测价值  

Prognostic prediction value of quantitative digital subtraction angiography parameters after mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion in the anterior circulation of different etiology

作　　者：黄抗默 刘锐 杜鹃 姚维和 查明明 秦山梅 徐燕 朱武生 赵清石 刘新峰 Huang Kangmo;Liu Rui;Du Juan;Yao Weihe;Zha Mingming;Qin Shanmei;Xu Yan;Zhu Wusheng;Zhao Qingshi;Liu Xinfeng(Department of Neurology,Affiliated Jinling Hospital(General Hospital of Eastern Theater Command),Medical School of Nanjing University,Nanjing 210002,China;Neusoft Medical Systems Co.,Ltd.,Shenyang 110179,China;Department of Neurology,Shenzhen Longhua District People′s Hospital,Shenzhen 518109,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)神经内科,南京210002 [2]东软医疗系统股份有限公司,沈阳110179 [3]深圳市龙华区人民医院神经内科,深圳518109

出　　处：《中华神经科杂志》2023年第6期637-645,共9页Chinese Journal of Neurology

基　　金：国家自然科学基金(U20A20357,81870946);江苏省重点研发计划(BE2020700)。

摘　　要：目的探究定量数字减影血管造影(DSA)参数在接受机械取栓治疗的急性前循环缺血性脑卒中患者中的预后预测价值,并分析对于不同病因型卒中患者其临床价值是否存在差异。方法对前瞻性多中心Captor试验进行事后分析,纳入于2018年4月至2019年7月成功再通的急性前循环大血管闭塞患者。对其再通后DSA造影序列进行后处理分析,于靶血管选定4个感兴趣区:感兴趣区1(颈内动脉C2段近端)、感兴趣区2(颈内动脉C7段起点)、感兴趣区3(大脑中动脉M1段末端)和感兴趣区4(大脑中动脉M2段末端)。达峰时间定义为感兴趣区内对比剂浓度达到峰值所对应的时间,相对达峰时间(rTTP)定义为所选感兴趣区与感兴趣区1的达峰时间差值。成功再通定义为术后改良脑梗死溶栓(mTICI)分级≥2b级,良好功能预后定义为术后3个月改良Rankin量表评分0~2分。根据改良Rankin量表评分将患者分为预后良好组和预后不良组,比较两组患者的临床特征、术后血流动力学参数等数据之间的差异。利用单因素、多因素Logistic回归分析良好预后的相关因素,并探究不同急性卒中Org10172治疗试验病因分型中血流动力学参数的预后预测价值。结果共收集245例患者,161例最终纳入分析[年龄69(60,76)岁,男性92例(57.1%)],其中大动脉粥样硬化(LAA)型卒中36例,心源性栓塞(CE)型76例,其他病因卒中49例。71例(44.1%)患者神经功能预后良好。术后血流动力学分析发现,预后良好患者(71例)比预后不良患者(90例)具有更高的术后mTICI 3级者比例[54/71(76.1%)比41/90(45.6%),χ^(2)=15.26,P<0.001]和更低的rTTP31[即达峰时间感兴趣区3-达峰时间感兴趣区1;0.33(0.23,0.54)s比0.47(0.31,0.65)s,Z=-2.71,P=0.007]。根据mTICI分级和rTTP31分别建立多因素回归模型,结果显示mTICI 3级(校正OR=5.97,95%CI 2.49~14.27,P<0.001)与rTTP31(校正OR=0.24,95%CI 0.06~0.99,P=0.048)都和患者良好的功能预后显著Objective To explore the prognostic prediction value of quantitative digital subtraction angiography(DSA)parameters in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy,and whether the clinical values vary by stroke etiology.Methods This study was a post hoc analysis of the Multicenter Prospective Captor Trial.Patients with acute anterior circulation large-vessel occlusion and successful recanalization from April 2018 to July 2019 were screened.Post-processing analysis was performed on the DSA imaging sequence after recanalization,and 4 regions of interest(ROI)were selected in the target vessel:ROI1(the proximal of the internal carotid artery-C2 segment),ROI2(the starting point of the internal carotid artery-C7 segment),ROI3(the end of the middle cerebral artery-M1 segment),and ROI4(the end of the middle cerebral artery-M2 segment).Time to peak(TTP)was defined as the time at contrast concentration of selected ROI reached its maximum.Relative TTP(rTTP)was calculated by subtracting the TTP of ROI1 from the TTP of distalis ROIs.Successful recanalization was defined as modified Thrombolysis In Cerebral Infarction(mTICI)grade≥2b.Favorable outcomes at 3 months were defined as the modified Rankin Scale score≤2.According to the modified Rankin Scale score,the patients were divided into good prognosis group and poor prognosis group.The differences in clinical characteristics,postoperative hemodynamic parameters,and other data were compared between patients with good and poor prognoses.Univariate and multivariate Logistic regression was used to analyze factors related to a good prognosis.Finally,the prognostic prediction value of hemodynamic parameters was analyzed in patients with different Trial of Org10172 in Acute Stroke Treatment etiological classifications.Results A total of 245 patients were collected,of which 161 patients[age 69(60,76)years,92(57.1%)male]were finally included in the analysis,including 36 cases of large artery atherosclerosis(LAA)stroke,76 cases of cardi

关 键 词：卒中 脑缺血 血管造影术 数字减影 预后 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]