Department of Neurology The First Hospital of Jilin University, Changchun, China.
Department of Ultrasound, The First Hospital of Jilin University, Changchun, China.
World Neurosurg. 2021 May;149:e128-e134. doi: 10.1016/j.wneu.2021.02.064. Epub 2021 Feb 20.
To investigate factors associated with poor clinical outcomes in patients with acute ischemic stroke undergoing endovascular therapy.
A retrospective review of 265 patients with acute ischemic stroke treated in the First Hospital of Jilin University between January 1, 2016, and November 1, 2019, was performed. The primary outcome was the proportion of patients with a modified Rankin score of 0-2 at 90 days. Univariate and multivariate analyses were performed to assess potential clinical factors associated with a poor 90-day outcome.
The rates of successful revascularization, good prognosis, symptomatic intracranial hemorrhage, and mortality were 84.5%, 46.0%, 9.8%, and 12.8%, respectively. As per univariate analysis, age, diagnosis of atrial fibrillation, diagnosis of diabetes, high baseline glucose level, tandem occlusion, high National Institutes of Health Stroke Scale (NIHSS) score at admission, general anesthesia, number of passes, high NIHSS score on discharge, unsuccessful recanalization (modified treatment in cerebral ischemia score <2b), and development of symptomatic intracranial hemorrhage, hemorrhagic infarction, parenchymal hematoma, and subarachnoid hemorrhage were associated with poor prognosis. Tobacco use was positive in correlation with good prognosis in univariate analysis. Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent factors associated with a poor 90-day outcome in multivariate analysis.
Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent risk factors associated with a poor 90-day outcome and should be considered a reference by neurointerventionalists in guiding their clinical decision-making.
探讨血管内治疗急性缺血性卒中患者临床预后不良的相关因素。
回顾性分析 2016 年 1 月 1 日至 2019 年 11 月 1 日在吉林大学第一医院接受治疗的 265 例急性缺血性卒中患者的临床资料。主要转归为 90 天时改良 Rankin 量表评分 0-2 分的患者比例。采用单因素和多因素分析评估与不良 90 天结局相关的潜在临床因素。
血管再通率、预后良好率、症状性颅内出血率和死亡率分别为 84.5%、46.0%、9.8%和 12.8%。单因素分析显示，年龄、心房颤动诊断、糖尿病诊断、基线血糖水平高、串联闭塞、入院时美国国立卫生研究院卒中量表（NIHSS）评分高、全身麻醉、通过次数、出院时 NIHSS 评分高、再通失败（改良脑梗死治疗评分<2b）以及症状性颅内出血、出血性梗死、脑实质血肿和蛛网膜下腔出血与预后不良相关。吸烟在单因素分析中与良好预后呈正相关。糖尿病、串联闭塞、入院时 NIHSS 评分高和全身麻醉是多因素分析中与 90 天预后不良相关的独立因素。
糖尿病、串联闭塞、入院时 NIHSS 评分高和全身麻醉是与 90 天预后不良相关的独立危险因素，神经介入医师在指导临床决策时应予以考虑。
