心源性栓塞和大动脉粥样硬化致缺血性脑卒中患者行血管内治疗的预后和安全性  

Prognosis and safety analysis of endovascular therapy in patients with ischemic stroke caused by cardiac embolism(CE)and major artery atherosclerosis(LAA)

作　　者：曾斌华[1] 王新刚[1] 万辉 ZENG Bin-Hua;WANG Xin-Gang;WAN Hui(Department of Neurosurgery,the Fourth Affiliated Hospital of Nanchang University,Nanchang 330003,Jiangxi,China)

机构地区：[1]南昌大学第四附属医院神经外科,江西南昌330003

出　　处：《吉林医学》2025年第4期805-809,共5页Jilin Medical Journal

摘　　要：目的:探讨心源性栓塞(CE)和大动脉粥样硬化(LAA)所致急性缺血性脑卒中(AIS)患者行血管内治疗的安全性及预后影响因素。方法:选取2018年1月~2022年12月南昌大学第四附属医院急诊收治的行机械取栓治疗的急性前循环大动脉闭塞致AIS 160例患者作为研究样本,根据改良TOAST病因分型分为CE组和LAA组各80例;回顾性分析两组血管内治疗的安全性指标和预后指标差异。再通过收集全体患者的相关影响因素指标,分析AIS血管内治疗预后的影响因素。结果:单因素分析显示,两组之间年龄、性别、体重指数(BMI)、高血压、糖尿病、呼吸系统疾病史、肾病史、吸烟史、全血细胞计数、血脂功能、肾功能、凝血功能、糖化血红蛋白、Alberta卒中操作早期急性卒中分级CT评分(ASPECTS)评分、取栓次数、股动脉穿刺-血管再通时间、症状性颅内出血、术后改良脑梗死溶栓(mTICI)分级、术后24 h CT血管造影(CTA)或磁共振血管成像(MRA)、术后7 d美国国立卫生研究院卒中量表(NIHSS)评分、全身并发症、手术装置相关并发症情况比较,差异无统计学意义(P>0.05);两组之间的心脏病史、美国介入治疗神经放射学会/介入放射学会(ASITN/SIR)分级、术中用药(替罗非班)、90 d改良Rankin评分量表(mRS)评分、90 d死亡、手术后出血情况比较,差异有统计学意义(P<0.05)。多因素分析显示,有心脏病史、ASITN/SIR 0-2级、术中用药(替罗非班)、90 d mRS评分>2分是导致卒中患者不良预后的危险因素。CE致AIS患者的90 d死亡率高于LAA致AIS患者,手术后出血风险高于LAA致AIS患者。结论:CE致AIS患者和LAA致AIS患者接受血管内治疗的预后和安全性基本一致,但CE致AIS患者的90 d死亡率和手术后出血风险更高。Objective To explore the safety and prognostic factors of endovascular therapy in patients with acute ischemic stroke(AIS)caused by cardiac embolism(CE)and large artery atherosclerosis(LAA).Methods Based on the classification of modified TOAS,the study sample of 160 patients with acute anterior circulation major artery blockage and AIS treated in an emergency hospital between January 2018 and December 2022 was split into 80 patients in the CE group and 80 patients in the LAA group.The differences in the safety and prognosis of endovascular treatment were retrospectively analyzed.Then,by collecting the relevant influencing factors of all patients,the influencing factors of endovascular treatment prognosis in AIS patients were analyzed.Results(1)Univariate analysis showed that,Between the two groups of age,sex,body quality index,hypertension,diabetes,history of respiratory disease,kidney disease,smoking,complete blood count,lipid function,renal function,coagulation function,glycated hemoglobin,Alberta stroke operation early acute stroke grade CT score(ASPECTS)score,number of times,femoral puncture-recanalization time,symptomatic intracranial hemorrhage,postoperative modified cerebral infarction thrombolysis(mTICI)grade,24 h after surgery Comparison of CT angiography(CTA)or magnetic resonance vascular imaging(MRA),7 d postoperative NIH Stroke Scale(NIHSS)scores,systemic complications,surgical device-related complications,There was no significant difference(P>0.05);Comparison of cardiac history between groups,American Society of interventional neuroradiology/Society of Interventional Radiotherapy(ASITN/SIR)grade,intraoperative medication(tirofiban),90 d modified Rankin score(mRS)score,90 d death,bleeding after surgery,The difference was statistically significant(P<0.05).(2)Multivariate analysis showed that a history of heart disease,ASITN/SIR grade 0~2,intraoperative medication(tirofiban),and 90 dmRS score>2 were risk factors leading to poor prognosis of stroke patients.(3)The 90 d mortality of patients with CE to AI

关 键 词：心源性栓塞 大动脉粥样硬化 缺血性脑卒中 机械取栓 血管内治疗 预后 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]