急性前循环缺血性卒中患者血管内治疗后需行去骨瓣减压术的预测因素  

Predictors of decompressive craniectomy after endovascular therapy in patients with acute anterior circulation ischemic stroke

作　　者：司俊臣 尹国阳[1] 郝继恒[1] 林凯[1] 崔庆轲[1] 王继跃[1] 张利勇[1] Si Junchen;Yin Guoyang;Hao Jiheng;Lin Kai;Cui Qingke;Wang Jiyue;Zhang Liyong(Department of Neurosurgery,Liaocheng People's Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院神经外科,252000

出　　处：《国际脑血管病杂志》2023年第1期1-5,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性前循环缺血性卒中患者血管内治疗(endovascular therapy,EVT)后需要进行去骨瓣减压(decompressive craniectomy,DC)的高危因素。方法回顾性纳入2018年1月到2020年1月在聊城市脑科医院因急性前循环大血管闭塞行EVT的患者,并分为DC组和非DC组。通过单变量和多变量logistic回归分析确定EVT后DC的危险因素。结果纳入207例患者,男性126例(60.87%),年龄(66.22±11.24)岁,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分为(19.84±9.20)分,阿尔伯塔卒中项目早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS)为(7.98±0.66)分。7例(5.80%)术后即刻改良脑缺血治疗(modified Treatment In Cerebral Ischemia,mTICI)血流分级≤2a级,30例(14.49%)术后出现出血性转化,28例(13.5%)接受DC。DC组和非DC组在既往卒中史、术前NIHSS评分和ASPECTS、血管闭塞部位、EVT时间、术后即刻mTICI≤2a级以及出血性转化方面差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,心房颤动[优势比(odds ratio,OR)3.202,95%置信区间(confidence interval,CI)1.335~9.796;P=0.011]、既往卒中史(OR 2.655,95%CI 1.016~6.938;P=0.046)、术前高NIHSS评分(OR 1.074,95%CI 1.026~1.124;P=0.002)、颈内动脉闭塞(OR 4.268,95%CI 1.399~13.024;P=0.011)、EVT时间较长(OR 1.010,95%CI 1.003~1.016;P=0.003)、mTICI≤2a级(OR 5.342,95%CI 1.565~18.227;P=0.007)以及术后出血性转化(OR 3.036,95%CI 1.024~9.004;P=0.045)是DC的独立危险因素。结论急性前循环缺血性卒中患者EVT后需要DC的情况并不少见。既往卒中史、心房颤动、基线高NIHSS评分、颈内动脉闭塞、EVT时间延长、mTICI≤2a级和术后出血性转化是EVT后需行DC的独立预测因素。Objective To investigate risk factors for decompressive craniectomy(DC)after endovascular therapy(EVT)in patients with acute anterior circulation ischemic stroke.Methods Patients underwent EVT due to acute anterior circulation large vessel occlusion in Liaocheng Brain Hospital from January 2018 to January 2020 were retrospectively included.They were divided into DC group and non-DC group.Univariate and multivariate logistic regression analyses were used to determine risk factors for DC after EVT.Results A total of 207 patients were enrolled,126 were male(60.87%),and their age was 66.22±11.24 years old.The baseline National Institutes of Health Stroke Scale(NIHSS)score was 19.84±9.20,and the Alberta Stroke Program Early CT Score(ASPECTS)was 7.98±0.66.The immediate postoperative modified Treatment In Cerebral Ischemia(mTICI)blood flow grade in seven patients(5.80%)was≤2a,30(14.49%)experienced hemorrhagic transformation(HT)after procedure,and 28(13.5%)received DC.There were statistically significant differences between the DC group and the non-DC group in terms of past stroke history,preoperative NIHSS score and ASPECTS,vascular occlusion site,EVT time,immediate postoperative mTICI≤2a,and HT(all P<0.05).Multivariate logistic regression analysis showed that atrial fibrillation(odds ratio[OR]3.202,95%confidence interval[CI]1.335-9.796;P=0.011),previous stroke history(OR 2.655,95%CI 1.016-6.938;P=0.046),high preoperative NIHSS score(OR 1.074,95%CI 1.026-1.124;P=0.002),internal carotid artery occlusion(OR 4.268,95%CI 1.399-13.024;P=0.011),longer EVT time(OR 1.010,95%CI 1.003-1.016;P=0.003),mTICI grade≤2a(OR 5.342,95%CI 1.565-18.227;P=0.007)and postoperative HT(OR 3.036,95%CI 1.024-9.004;P=0.045)were independent risk factors for DC.Conclusions It is not uncommon for patients with acute anterior circulation ischemic stroke to need DC after EVT.Previous stroke history,atrial fibrillation,high baseline NIHSS score,internal carotid artery occlusion,prolonged blood EVT time,mTICI grade≤2a and postoperative HT are i

关 键 词：缺血性卒中 血管内手术 血栓切除术 减压颅骨切除术 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]