前后循环大血管闭塞型缺血性脑卒中血管成功再通后临床预后的比较  

Comparison of clinical prognoses of anterior and posterior circulatory large vessel occlusive ischemic stroke after successful endovascular recanalization

作　　者：思宇涛 尹琳[1] 马春野[1] 孙大鹏 Si Yutao;Yin Lin;Ma Chunye;Sun Dapeng(Stroke Center,Second Hospital of Dalian Medical University,Dalian 116023,China;Center of Neurointervention,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]大连医科大学附属第二医院卒中中心,大连116023 [2]首都医科大学附属北京天坛医院神经介入中心,北京100070

出　　处：《中华神经医学杂志》2023年第10期1016-1022,共7页Chinese Journal of Neuromedicine

摘　　要：目的:探讨前后循环大血管闭塞型缺血性脑卒中患者间临床特点及其血管成功再通后临床预后的差异。方法:回顾性连续纳入大连医科大学附属第二医院卒中中心自2016年1月至2022年9月收治的170例大血管闭塞型缺血性脑卒中患者为研究对象,患者行血管内治疗后血管再通程度均达到改良脑梗死溶栓(mTICI)分级2b/3级。根据血管闭塞部位将患者分为前循环大血管闭塞组(138例)与后循环大血管闭塞组(32例),对比2组患者间临床资料、血管内治疗相关参数及临床预后指标的差异。结果:后循环大血管闭塞组患者中男性、动脉粥样硬化型比例明显高于前循环大血管闭塞组(81.3%vs.61.6%,78.1%vs.47.1%),中性粒细胞与淋巴细胞比值、入院时美国国立卫生研究院卒中量表(NIHSS)评分明显高于前循环大血管闭塞组[3.78(1.93,10.86)vs.2.77(1.77,4.72),(20.50±8.96)分vs.(14.83±4.67)分],心房颤动史比例明显低于前循环大血管闭塞组(21.9%vs.58.0%),发病至血管穿刺时间、发病至血管再通时间、入院至血管穿刺时间、入院至血管再通时间明显长于前循环大血管闭塞组[367.50(246.25,630.00)min vs.240.00(198.75,330.00)min,515.00(292.50,701.25)min vs.345.50(270.00,425.75)min,163.00(123.25,218.50)min vs.125.50(97.00,161.00)min,258.00(200.25,389.00)min vs.219.50(178.00,276.25)min],术后24 h NIHSS评分、出院时NIHSS评分、90 d内死亡率明显高于前循环大血管闭塞组[(21.31±9.23)分vs.(15.74±6.53)分,25.50(4.25,40.25)分vs.10.00(4.00,18.25)分,40.6%vs.20.3%],差异均有统计学意义(P<0.05),但2组患者间症状性颅内出血及颅内出血发生率、住院期间死亡率及90 d预后良好率的差异均无统计学意义(P>0.05)。结论:后循环大血管闭塞型缺血性脑卒中患者发病时神经功能缺损程度高于前循环大血管闭塞型患者,但血管成功再通后,2组患者的90 d预后及并发症情况并无明显差异,仅前者的90 d内死亡风�Objective To analyze the clinical characteristics of patients with anterior and posterior circulation large vessel occlusion ischemic stroke and clinical prognoses after successful endovascular recanalization.Methods A retrospective analysis was performed;170 patients with large vessel occlusive ischemic stroke,admitted to Stroke Center,Second Hospital of Dalian Medical University from January 2016 to September 2022 were chosen;these patients had modified Thrombolysis in Cerebral Infarction(mTICI)2b or 3 after endovascular treatment.These patients were divided into anterior-circulation large vessel occlusion group(n=138)and posterior-circulation large vessel occlusion group(n=32)according to the locations of vessel occlusion.Clinical data,parameters related to endovascular treatment,and clinical prognoses of the 2 groups were collected and compared.Results Posterior-circulation large vessel occlusion group had significantly higher percentages of male patients and patients with atherosclerotic type(81.3%vs.61.6%;78.1%vs.47.1%),significantly higher ratio of neutrophil to lymphocyte and NIHSS scores(3.78[1.93,10.86]vs.2.77[1.77,4.72];20.50±8.96 vs.14.83±4.67),significantly lower percentage of patients with atrial fibrillation(21.9%vs.58%),and significantly longer times from onset to puncture,onset to recalculation,admission to puncture,and admission to recalculation(367.50[246.25,630.00]min vs.240.00[198.75,330.00];515.00[292.50,701.25]vs.345.50[270.00,425.75]min;163.00[123.25,218.50]min vs.125.50[97.00,161.00];258.00[200.25,389.00]vs.219.50[178.00,276.25])than anterior-circulation large vessel occlusion group(P<0.05).The NIHSS scores 24 h after endovascular treatment,NIHSS scores at discharge,and mortality within 90 d in posterior-circulation large vessel occlusion group were significantly higher than those in anterior-circulation large vessel occlusion group(21.31±9.23 vs.15.74±6.53;25.5[4.25,40.25]vs.10.00[4.00,18.25];40.6%vs.20.3%,P<0.05);however,no significant differences in symptomatic intracranial hemorrh

关 键 词：前循环 后循环 缺血性脑卒中 大血管闭塞 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]