Yu Cheng-Sheng, Lin Chih-Ming, Liu Chi-Kuang, Lu Henry Horng-Shing
Institute of Statistics and Big Data Research Center, National Chiao Tung University, Taiwan, Republic of China.
Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China; Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, Republic of China.
Ther Clin Risk Manag. 2016 Mar 31;12:495-504. doi: 10.2147/TCRM.S104933. eCollection 2016.
Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS) was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline mRS scores >2.
颈动脉支架置入术是治疗中度至重度颈动脉狭窄缺血性卒中患者的有效方法。然而，接受该手术患者的中期预后因基线特征的不同而有很大差异。为了确定基线特征对颈动脉支架置入术后预后的影响，通过回顾性病历审查收集了107例首次缺血性卒中合格患者的数据。采用改良Rankin量表（mRS）将患者分为两个基线组，mRS≤2和mRS>2。进行了三步决策树统计分析。对决策树参数进行加权后，得到以下影响层次：入院时低密度脂蛋白、痛风性关节炎、慢性肾脏病、同侧颈总动脉阻力指数、对侧眼动脉阻力指数、性别和血脂异常。有限状态机模型显示，在基线mRS≤2的患者中，46%在随访时mRS评分改善，而54%的患者mRS评分稳定。在基线mRS>2的患者中，75%观察到mRS评分稳定，23%评分改善，2%评分较差。入院时低密度脂蛋白是影响支架置入术后预后的最强预测因素。此外，我们的研究进一步证明，颈动脉支架置入术对基线mRS评分>2的首次缺血性卒中患者有益。
