非急性长段颈内动脉闭塞血管内治疗再通的影响因素分析  

Factors analysis on success rate of endovascular recanalization for non-acute long segmental internal carotid artery occlusion

作　　者：刘朝[1] 王子尧 刘兵辉 李进一[1] 陈振[1] 徐浩文[1] 管生[1] Liu Chao;Wang Ziyao;Liu Binghui;Li Jinyi;Chen Zhen;Xu Haowen;Guan Sheng(Department of Interventional Neuroradiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450052

出　　处：《中华放射学杂志》2023年第11期1239-1245,共7页Chinese Journal of Radiology

基　　金：河南省高等学校重点科研项目计划(23A320013);河南省重点研发与推广专项(科技攻关)(232102310079)。

摘　　要：目的探讨非急性长段颈内动脉闭塞成功血管内再通的影响因素, 并提出1种新的简化分型指导临床治疗。方法回顾性分析2018年1月至2022年10月在郑州大学第一附属医院接受非急性颈内动脉闭塞血管内治疗患者的临床资料、实验室数据、影像表现和介入操作方式。将入院并接受血管内开通治疗的120例患者纳入分析, 以颈内动脉是否成功开通进行分组, 利用组间分析筛选有意义变量, 通过单因素和多因素logistic回归分析, 寻找影响血管内再通的独立危险因素。同时, 根据既往文献结合自身数据, 利用眼动脉是否反流代偿和残端是否尖锐两个变量的组合分为A~D 4型:A型, 尖锐残端(-), 眼动脉反流(-);B型, 尖锐残端(-), 眼动脉反流(+);C型, 尖锐残端(+), 眼动脉反流(-);D型, 尖锐残端(+), 眼动脉反流(+), 探讨分型对开通结果的影响。结果 120例患者中, 成功血管内开通91例(75.83%), 围手术期并发症11例(9.17%)。其中出血事件4例(3.33%), 包括症状性脑出血1例(0.83%);缺血事件1例(0.83%), 导管穿孔1例(0.83%), 颈动脉海绵窦瘘3例(2.50%), 夹层2例(1.67%)。无致残性并发症及死亡病例发生。单因素和多因素logistic回归分析显示, 尖锐残端(OR=4.10, 95%CI 1.19~14.16)、眼动脉反流(OR=3.16, 95%CI 1.13~8.88)和单纯颅外段闭塞(OR=10.78, 95%CI 2.08~55.74)是影响非急性期颈内动脉闭塞血管内开通的独立危险因素。A~D型手术成功率分别为30.00%(3/10)、66.67%(8/12)、70.00%(28/40)、89.66%(52/58), 围手术期并发症发生率分别为10.00%(1/10)、8.33%(1/12)、17.50%(7/40)、3.45%(2/58)。结论尖锐残端、眼动脉反流代偿和闭塞段局限于颅外段是成功开通的独立危险因素。以残端是否尖锐和眼动脉是否反流代偿两种变量构成的分组模型, 对指导非急性闭塞血管的开通具有一定积极意义。Objective To investigate the risk factors related to successful endovascular recanalization for non-acute long segmental occlusion of internal carotid artery and propose a strategy for selecting proper candidates for such procedure.Methods From January 2018 to October 2022,120 consecutive patients with non-acute long segmental internal carotid artery occlusion received the first intended endovascular recanalization treatment in the First Affiliated Hospital of Zhengzhou University.Potential variables including epidemiology,symptomatology,angiographic morphology and interventional techniques were retrospectively analyzed.Univariate and multivariate logistic regression analyses were made to investigate the independent risk factors for successful recanalization.Four types were divided according to the existence of tapered stump and ophthalmic artery flow reversion based on DSA images:A:tapered stump(-),ophthalmic artery flow reversion(-);B:tapered stump(-),ophthalmic artery flow reversion(+);C:tapered stump(+),ophthalmic artery reversion(-);D:tapered stump(+),ophthalmic artery(+).Investigation of the relationship between procedure success rate and group dividing was performed.Results Totally 120 patients were all included.The technical success rate was 75.83%(91/120).The periprocedural complication rate was 9.17%(11/120),including 4(3.33%)intracranial hemorrhagic events,1(0.83%)ischemic stroke event,1(0.83%)microcatheter perforation,3(2.75%)cavernous carotid fistulas,2(1.67%)iatrogenic dissections.None of these complications led to severe neurological damage or death.Through multivariate logistic regression,tapered stump(OR=4.10,95%CI 1.19-14.16),retrograde filling of ophthalmic artery(OR=3.16,95%CI 1.13-8.88),only cervical segment occlusion of internal carotid artery(OR=10.78,95%CI 2.08-55.74)were the independent risk factors associated with higher technical success rate.All cases were divided into A-D four types considering the tapered stump and reversed ophthalmic flow existing or not.Technical success rates in A

关 键 词：颈内动脉 闭塞 缺血性卒中 血管内治疗 造影分型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]