发病24小时内急性椎-基底动脉闭塞血管内治疗预后的影响因素分析  

Analysis of factors influencing the prognosis of endovascular treatment of acute vertebrobasilar occlusion within 24 hours of onset of disease

作　　者：周佳男 张洋 周志龙 赵新宇 乔婷婷 吴立恒 管民 马振凯 裴小溪 周腾飞 朱良付 Zhou Jianan;Zhang Yang;Zhou Zhilong;Zhao Xinyu;Qiao Tingting;Wu Liheng;Guan Min;Ma Zhenkai;Pei Xiaoxi;Zhou Tengfei;Zhu Liangfu(Department of Cerebrovascular Diseases,People′s Hospital of Zhengzhou University(Henan Provincial People′s Hospital),Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院(河南省人民医院)脑血管病科,450003

出　　处：《中国脑血管病杂志》2024年第12期793-801,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：国家十四五重点研发计划项目(2022YFC2408800)。

摘　　要：目的探讨影响发病24 h内急性椎-基底动脉闭塞(AVBAO)行血管内治疗(EVT)预后的相关因素。方法回顾性连续纳入2020年10月至2023年9月河南省人民医院脑血管病科收治的发病24 h内接受EVT治疗的AVBAO患者。收集患者的一般资料和临床资料,包括年龄、性别、卒中相关危险因素(高脂血症、高血压病、糖尿病、心房颤动、冠心病、吸烟、既往卒中)、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前改良Rankin量表(mRS)评分、起病形式、术前静脉溶栓、后循环Alberta卒中项目早期CT评分(pc-ASPECTS)、基底动脉CT血管成像(BATMAN)评分、闭塞部位(椎动脉颅内段、基底动脉)及手术相关资料,包括治疗方式[直接导管抽吸取栓和(或)支架取栓、球囊扩张、支架置入等;首选支架置入或球囊扩张为直接血管成形术,若取栓术后血流不能维持需进一步行球囊扩张和(或)支架置入则为补救血管成形术]、发病至穿刺时间(OPT)、穿刺至血管再通时间(PRT)、术后即刻改良脑梗死溶栓(mTICI)分级(以mTICI分级2b或3级为血管成功再通)、围手术期并发症[术中栓子逃逸、术中再闭塞、术中夹层、术后3 d内出血转化和术后3 d内症状性颅内出血(sICH)]。以术后90 d mRS评分评估患者预后,mRS评分≤3分为预后良好,mRS评分>3分为预后不良。纳入单因素分析结果中P<0.1的指标,采用向后剔除法筛选变量并进行多因素Logistic回归分析,对发病24 h内AVBAO患者行EVT预后的影响因素进行分析。结果共纳入接受EVT的AVBAO患者149例,其中预后良好患者79例,预后不良患者70例,术后即刻血管成功再通患者145例,发生围手术期并发症34例,死亡32例。(1)单因素分析结果显示,与预后不良患者相比,预后良好患者的术前NIHSS评分[16.0(12.0,23.0)分比24.5(16.8,31.3)分,Z=-4.280,P<0.01]和术前mRS评分[4(4,4)分比5(4,5)分,Z=-4.711,P<0.01]均更低,糖尿病患者比例更低[1Objective To investigate the factors affecting the prognosis of endovascular treatment(EVT)for acute vertebrobasilar artery occlusion(AVBAO)within 24 h of onset of disease.Methods General and clinical data of AVBAO patients admitted to the Department of Cerebrovascular Diseases,Henan Provincial People′s Hospital who received EVT within 24 h of onset from October 2020 to September 2023 were retrospectively and consecutively included,including age,sex,stroke-related risk factors(hyperlipidemia,hypertension,diabetes mellitus,atrial fibrillation,coronary artery disease,smoking,and previous stroke),preoperative National Institutes of Health stroke scale(NIHSS)score,preoperative modified Rankin scale(mRS)score,form of onset,preoperative intravenous thrombolysis,posterior circulation Alberta stroke program early CT score(pc-ASPECTS),basilar artery on computed tomography angiography(BATMAN)score,site of occlusion(intracranial segment of vertebral artery,basilar artery),and surgical procedure(direct aspiration and/or stent-retrieval,balloon dilatation,stenting,etc.First-line stenting or balloon dilatation is direct angioplasty;if blood flow cannot be maintained after thrombectomy,further balloon dilatation and/or stenting is required as remedial angioplasty),onset-to-puncture time,puncture-to-recanalization time,and postprocedure immediate modified thrombolysis in cerebral infarction(mTICI)grading(successful recanalization was defined as mTICI grading 2b or 3),and perioperative complications(intraprocedural thrombus migration,intraprocedural reocclusion,intraprocedural dissection,postoperative hemorrhagic transformation within 3 d,and symptomatic intracranial hemorrhage[sICH]).Patient prognosis was assessed by mRS score at 90 d postoperatively.The mRS score≤3 was classified as good prognosis,and mRS score>3 was classified as poor prognosis.Indicators with P<0.1 in the results of univariate analysis were included,and variables were screened by backward elimination and subjected to multifactorial Logistic regression ana

关 键 词：卒中 预后 血管成形术 椎-基底动脉闭塞 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]