急性前循环动脉粥样硬化和动脉夹层串联闭塞患者血管内治疗的预后分析  

Clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions due to atherosclerosis and dissection

作　　者：李佳 郭章宝[1] 唐坤[1] 万小林 杨运 倪厚杰[1] 朱明辉 郭方亮 刘文华 Li Jia;Guo Zhangbao;Tang Kun;Wan Xiaolin;Yang Yun;Ni Houjie;Zhu Minghui;Guo Fangliang;Liu Wenhua(Department of Neurology,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院神经内科,武汉430022

出　　处：《中华内科杂志》2023年第11期1317-1322,共6页Chinese Journal of Internal Medicine

基　　金：武汉市卫生健康委员会科研计划项目(WX21C09)。

摘　　要：目的探讨动脉粥样硬化和动脉夹层所致急性前循环串联闭塞性卒中患者接受血管内治疗后的临床转归差异。方法回顾性队列研究。收集2016年3月至2022年3月武汉市第一医院接受血管内治疗的前循环串联病变患者98例,中位数年龄为64(55,71)岁,男性占82.7%(81/98)。根据病因分为动脉粥样硬化组和夹层组,并比较2组的临床转归:良好的90 d功能预后(改良Rankin量表0~2分)、成功血管再通(改良脑梗死溶栓血流分级2b~3级)、症状性颅内出血、卒中相关性肺炎、90 d全因病死率及平均住院天数。logistic回归分析用来校正影响2组患者功能预后的潜在混杂因子,并得出优势比(OR)及95%可信区间(CI)。结果纳入动脉粥样硬化组71例,夹层组27例。动脉粥样硬化组良好功能转归率为43.7%(31/71),夹层组为55.6%(15/27);经校正后,OR=1.339,95%CI 0.374~4.798,P=0.654。2组间其他临床结局差异均无统计学意义(均P>0.05)。结论前循环动脉粥样硬化和动脉夹层串联病变患者接受血管内治疗后的临床结局相似。未来仍需研究进一步验证。Objective To compare the clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions caused by atherosclerosis or dissection.Methods A retrospective cohort study.A total of 98 patients with anterior circulation tandem lesions undergoing endovascular therapy in the Wuhan NO.1 Hospital(March 2016 to March 2022)were analyzed.Median age was 64(55,71)years old,and 82.7%(81/98 cases)were males.According to the lesion etiology,the patients were divided into atherosclerosis and dissection groups.The differences in clinical outcomes between the two groups were investigated,including favorable 90-day functional outcome(modified Rankin Scale score of 0-2),successful reperfusion(modified Thrombolysis in Cerebrovascular Infarction score of 2b-3),symptomatic intracranial hemorrhage,stroke-associated pneumonia,90-day all-cause mortality,and average hospitalization days.Logistic regression analysis was used to adjust for potential confounders affecting functional outcomes in both groups,and to determine odds ratios and 95%confidence intervals.Results Seventy-one patients were grouped into the atherosclerotic cause and 27 into the dissection cause cohorts.The rate of favorable 90-day functional outcome was 43.7%(31/71 cases)in the atherosclerosis group versus 55.6%(15/27 cases)in the dissection group(adjusted odds ratio=1.339;95%confidence interval,0.374-4.798;P=0.654).No significant differences were found in other clinical outcomes between the two groups(all P>0.05).Conclusion The clinical prognosis of patients with tandem lesions caused by atherosclerotic stenosis or artery dissection was similar after endovascular therapy.Future studies are still needed to verify our results.

关 键 词：大脑梗死 动脉闭塞性疾病 颈内动脉 大脑中动脉 血栓切除术 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]