侧支状态对老年急性大血管闭塞患者Solitaire支架取栓术后预后的影响及预测模型  

Effect of collateral status on prognosis in elderly patients with AIS-LVO after SWIM and construction of a prediction model for poor prognosis

作　　者：姚广明 田甜[1] 呼铁民[1] 杨宗幸 褚会松 张继伟[1] Yao Guangming;Tian Tian;Hu Tiemin;Yang Zongxing;Chu Huisong;Zhang Jiwei(Department of Neurosurgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei Province,China)

机构地区：[1]承德医学院附属医院神经外科,067000

出　　处：《中华老年心脑血管病杂志》2025年第3期308-312,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：2022年度河北省医学科学研究课题计划(20220429)。

摘　　要：目的探讨侧支状态对老年急性大血管闭塞性缺血性脑卒中(acute ischemic stroke due to large vessel occlusion,AIS-LVO)患者颅内支撑导管辅助Solitaire支架取栓术(Solitarie stent with intracranial support catheter for mechanical thrombectomy,SWIM)后预后的影响及预测模型建立。方法回顾性分析2019年2月至2024年2月承德医学院附属医院240例老年AIS-LVO患者行SWIM治疗的临床资料,依3:1的比例按性别、年龄、闭塞部位、TOAST分型将患者分为建模组180例和验证组60例,根据术后3个月患者改良的Rankin量表评分结果,将0~2分定义为预后良好;3~6分定义为预后不良,将建模组分为预后良好组97例和预后不良组83例,采用logistic回归分析侧支循环状态与患者预后的关系,筛选患者预后影响因素并构建预测模型,经ROC曲线评估模型效度。结果建模组随访3个月结果显示,预后不良组后循环闭塞、心源性栓塞型、神经放射学学会/美国介入放射学学会3~4级、出血转化、入院时美国国立卫生研究院卒中量表评分、发病至血管再通时间显著高于预后良好组,入院时ASPECTS评分显著低于预后良好组,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,闭塞部位、TOAST分型、入院时美国国立卫生研究院卒中量表评分、发病至血管再通时间、出血转化是AIS-LVO行SWIM治疗患者预后不良的独立危险因素,入院时ASPECTS评分、侧支循环是患者预后良好的保护因素(P<0.01)。建模组AIS-LVO行SWIM患者术后3个月不良预后,采用Hosmer-Lemeshow检验检测回归方程的拟合优度(P=0.435)。利用建模组数据进行验证,ROC曲线下面积为0.855(95%CI:0.797~0.913),敏感性为81.93%,特异性为79.38%;利用验证组数据进行验证,验证组随访3个月包括预后良好者34例以及预后不良者26例,ROC曲线下面积为0.839(95%CI:0.732~0.947),敏感性为84.62%,特异性为79.41%。结论对AIS-LVO行SWIM老年患者分析并Objective To explore the effect of collateral status on prognosis in elderly patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)after Solitaire stent retriever in combination with the intracranial support catheter aspiration for mechanical thrombectomy(SWIM),and construct a prediction model for prognosis.Methods A retrospective analysis was performed on 240 elderly AIS-LVO patients who underwent SWIM technique in our hospital between February 2019 and February 2024.According to gender,age,occlusion sites and TOAST classifications,they were divided into a modeling group(180 cases)and a verification group(60 cases)in a ratio of 3:1.Based on the results of modified Rankin scale(mRS)at 3 months after surgery,the patients in the modeling group were further divided into good prognosis subgroup(mRS score:0-2,97 cases)and poor prognosis subgroup(mRS score:3-6,83 cases).Multivariate logistic regression analysis was applied to evaluate the relationship between preoperative collateral circulation status and prognosis and to identify the influencing factors for prognosis.Then a prediction model for prognosis was constructed,and its performance was evaluated by ROC curve analysis.Results In the modeling group at 3 months of follow-up,the poor prognosis subgroup had significantly larger proportions of posterior circulation occlusion,cardiogenic embolism,ASITN/SIR grades 3-4 and hemorrhage transformation,higher NIHSS score at admission and longer interval from onset to vascular recanalization,while lower ASPECTS score at admission when compared with the good prognosis subgroup(P<o.01).Multivariate logistic regression analysis showed that occlusion site,TOAST classification,NIHSS score at admission,interval from onset to vascular recanalization and hemorrhage transformation were independent risk factors for poor prognosis,while ASPECTS score at admission and collateral circulation were protective factors of good prognosis in the elderly AIS-LVO patients after SWIM technique(P<o.01).Hosmer-Lemeshow test sho

关 键 词：脑血管障碍 侧支循环 球囊取栓术 预后 

分 类 号：R651.12[医药卫生—外科学]