急性前循环缺血性脑卒中机械取栓成功再通后无效再通的危险因素分析  

Risk factors of futile recanalization after mechanical thrombectomy for acute anterior circulation stroke

作　　者：张仁伟[1] 刘振兴 欧阳克妮 蔡琪[1] 谢玉[1] 刘煜敏[1] ZHANG Ren-wei;LIU Zhen-xing;OUYANG Ke-ni;CAI Qi;XIE Yu;LIU Yu-min(Department of Neurology,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430000,China)

机构地区：[1]武汉大学中南医院神经内科,湖北武汉430000

出　　处：《中华实用诊断与治疗杂志》2023年第6期605-609,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省重点研发计划(2020BCB028)。

摘　　要：目的观察前循环大血管闭塞(large vessel occlusion,LVO)急性脑卒中(acute ischemic stroke,AIS)患者机械取栓(mechanical thrombectomy,MT)成功再通后无效再通的发生情况,分析其无效再通的危险因素。方法120例行MT成功再通的前循环LVO-AIS患者,根据MT术后90 d Rankin评分(modified Rankin scale,mRS)分为有效再通组(mRS评分≤2分)42例和无效再通组(mRS评分>2分)78例,比较2组年龄、性别比例、ASPECTS评分、入院时NIHSS评分等临床资料。采用多因素logistic回归分析前循环LVO-AIS患者MT成功再通后出现无效再通的影响因素;绘制ROC曲线,评估年龄、入院时NIHSS评分、症状性颅内出血(symptomatic intracranial hemorrhage,sICH)及并发症预测前循环LVO-AIS患者MT成功再通后出现无效再通的效能。结果120例患者术后90 d无效再通78例(90 d mRS评分3~6分),无效再通率为65.0%。无效再通组年龄[66.00(57.00,74.00)岁]大于有效再通组[62.50(48.25,72.25)岁](Z=-2.032,P=0.044),ASPECTS评分>8分比率(41.0%)低于有效再通组(66.7%)(χ^(2)=6.190,P=0.013),男性和糖尿病比率(64.1%、38.5%)、入院时NIHSS评分[18.00(14.25,23.00)分]、sICH和并发症发生率(33.3%、92.3%)及90 d mRS评分[4.00(3.00,5.75)分]均高于有效再通组[42.9%、16.7%、14.00(12.00,15.75)分、4.8%、61.9%、2.00(1.00,2.00)分](P<0.05)。年龄(OR=1.040,95%CI:1.000~1.080,P=0.041)、入院时NIHSS评分(OR=1.130,95%CI:1.020~1.250,P=0.016)、sICH(OR=5.930,95%CI:1.080~32.730,P=0.041)、并发症(OR=4.540,95%CI:1.340~15.370,P=0.015)是前循环LVO-AIS患者MT成功再通后出现无效再通的影响因素。年龄、入院时NIHSS评分以55.5岁、15.5分为最佳截断值,预测前循环LVO-AIS患者MT成功再通后出现无效再通的AUC分别为0.592(95%CI:0.480~0.703,P=0.010)、0.735(95%CI:0.644~0.825,P<0.001),灵敏度分别为80.77%、69.23%,特异度分别为40.48%、73.81%;有sICH、并发症预测前循环LVO-AIS患者MT成功再通后出现无效再通的AUC分别为0.643(95Objective To observe the occurrence of futile recanalization after successful recanalization by mechanical thrombectomy(MT)in patients with acute anterior large vessel occlusion(LVO)induced acute ischemic stroke(AIS),and to investigate the risk factors of futile recanalization.Methods According to the modified Rankin scale(mRS)score90 days after MT,120 patients with anterior circulation LVO-AIS were divided into effective recanalization group(mRS score≤22,n=42)and futile recanalization group(mRS score>2,n=78).The baseline data as the age,gender ratio,ASPECTS score and admission NIHSS were compared between two groups.Multivariate logistic regression was done to analyze the influencing factors of futile recanalization after successful recanalization by MT in patients with anterior circulation LVO-AIS.The ROC curve was drawn to evaluate the efficiencies of the age,admission NIHSS,symptomatic intracranial hemorrhage(sICH)and complications on predicting futile recanalization.Results In 120 patients,there were78 patients(65.0%)with futile recanalization 90 days after MT(90-d mRS score:3-6).The patients were older in futile recanalization group[66.00(57.00,74.00)years]than those in effective recanalization group[62.50(48.25,72.25)years](Z=-2.032,P=0.044),and the proportion of ASPECTS score of>8 was lower in futile recanalization group(41.0%)than that in effective recanalization group(66.7%)(χ^(2)=6.190,P=0.013).The percentages of male patients and patients with diabetes mellitus,admission NIHSS score,incidence of complications and 90-d mRS score were higher in futile recanalization group[64.10%,38.5%,18.00(14.25,23.00),33.3%,92.3%,4.00(3.00,5.75)]than those in effective recanalization group[42.9%,16.7%,14.00(12.00,15.75),4.8%,61.9%,2.00(1.00,2.00)](P<0.05).The age(OR=1.040,95%CI:1.000-1.080,P=0.041),admission NIHSS score(OR=1.130,95%CI:1.020-1.250,P=0.016),sICH(OR=5.930,95%CI:1.080-32.730,P=0.041)and complications(OR=4.540,95%CI:1.340-15.370,P=0.015)were the influencing factors of futile recanalization after successf

关 键 词：急性缺血性卒中 大血管闭塞 机械取栓 无效再通 

分 类 号：R743.3[医药卫生—神经病学与精神病学]