发病时间大于24小时急性后循环缺血性卒中血管内治疗的安全性与有效性分析  

Safety and efficacy of endovascular treatment in patients with acute posterior circulation ischemic stroke over 24 hours from onset:a propensity score matched cohort study

作　　者：岳飞学 李超[1] 宋康佳 石明超[1] 李超 周杰[1] 张文彬[1] 王守春 Yue Feixue;Li Chao;Song Kangjia;Shi Mingchao;Li Chao;Zhou Jie;Zhang Wenbin;Wang Shouchun(Stroke Center,Department of Neurology,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院神经内科卒中中心,长春130021

出　　处：《中国脑血管病杂志》2023年第12期816-824,836,共10页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨发病时间>24 h急性后循环缺血性卒中患者行血管内治疗(EVT)的安全性与有效性。方法回顾性连续纳入2018年6月至2023年6月于吉林大学第一医院神经内科卒中中心接受EVT的急性后循环缺血性卒中患者的临床资料。收集患者的性别、年龄等相关人口统计学信息;收集患者相关检查结果,包括入院快速血糖、入院收缩压、入院舒张压;收集患者的卒中相关危险因素,包括既往短暂性脑缺血发作、高血压病、糖尿病、心房颤动以及饮酒史、吸烟史等;收集其他相关指标,包括是否静脉溶栓、串联病变、觉醒卒中及基线美国国立卫生研究院卒中量表(NIHSS)评分、基线后循环Alberta卒中项目早期CT评分(pc-ASPECTS)、美国介入和治疗神经放射学学会/介入放射学学会(ASITN/SIR)侧支循环分级、发病至EVT穿刺时间、急性卒中Org 10172治疗试验(TOAST)分型及结局指标[有效性指标包括术后90 d改良Rankin量表(mRS)评分≤3分、术后即刻造影是否成功再通(扩展脑梗死溶栓分级2b~3级);安全性指标包括术后24 h内症状性颅内出血(sICH)及术后90 d病死率]。根据患者发病至EVT穿刺时间将患者分别纳入发病时间>24 h组及发病时间≤24 h组。通过倾向性评分匹配(PSM)的统计方法将发病间>24 h的患者及发病时间≤24 h的患者以1∶1的比例进行匹配。根据术后90 d mRS评分将所有患者分为预后不良(mRS评分>3分)组和预后良好(mRS评分≤3分)组。采用单因素和多因素Logistic回归分析方法分析发病时间对术后90 d预后的影响。结果本研究共纳入366例患者,其中男284例,女82例;年龄25~91岁,中位年龄61(55,68)岁。PSM前发病时间≤24 h组267例,发病时间>24 h组99例,PSM后两组均为94例。未行PSM匹配前,发病时间>24 h组心房颤动比例更低[2.0%(2/99)比9.7%(26/267),P=0.025],基线NIHSS评分更低[10.0(5.0,19.0)分比14.0(10.0,35.0)分,P<0.01],两组间ASTIN/SIR�Objective To explore the safety and efficacy of endovascular treatment(EVT)in patients with acute posterior circulation ischemic stroke over 24 hours from onset.Methods This retrospective study retrospectively analyzed patients with acute posterior circulation ischemic stroke who received EVT in the Department of Neurology,First Hospital of Jilin University from June 2018 to June 2023.The patient′s gender,age and other related demographic information were collected.The related examination results of patients were collected,including admission rapid blood glucose,admission systolic blood pressure,admission diastolic blood pressure.The related risk factors of stroke of patients were collected,including previous transient ischemic attack,hypertension,diabetes,atrial fibrillation,and history of drinking,smoking history,etc.;other related indicators were collected,including intravenous thrombolysis,tandem lesions,awakening stroke,baseline National Institutes of Health stroke scale(NIHSS)score,and baseline posterior circulation Alberta stroke program early CT score(pc-ASPECTS),collateral circulation grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR),onset to EVT puncture time,the trial of org 10172 in acute stroke treatment(TOAST)classification and outcome indicators(efficacy indicators included 90 days Modified Rankin scale[mRS]score≤3 after EVT,successful recanalization[extended cerebral infarction thrombolytic recanalization class 2b-3];security indexes included symptomatic intracranial hemorrhage[sICH]within 24 h after EVT and 90 d mortality after EVT).According to the symptom onset to EVT puncture time,the patients were divided into two groups:≤24 h group and>24 h group.The patients with onset time>24 h and those with onset time≤24 h were matched at a ratio of 1∶1 by propensity score matching(PSM).All patients were divided into poor prognosis group(mRS score>3)and good prognosis group(mRS score≤3)according to mRS score at 90 days af

关 键 词：缺血性卒中 后循环 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]