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[颅内前循环大血管闭塞急性缺血性卒中血管内治疗后无效再通相关因素分析]

[Analysis of factors associated with futile recanalization after endovascular treatment for acute ischemic stroke with large vessels occlusion in anterior intracranial circulation].

作者信息

Yue C S, Li L Y, Tian Y, Yang J, Hu J R, Liu X, Peng Z Z, Chen L, Yang Q W, Zi W J

机构信息

Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 Aug 8;103(29):2225-2232. doi: 10.3760/cma.j.cn112137-20230104-00018.

DOI:10.3760/cma.j.cn112137-20230104-00018
PMID:37544758
Abstract

To analyze the related factors of futile recanalization (FR) after emergency endovascular treatment of large artery occlusion in anterior circulation. Three studies on endovascular treatment of acute anterior circulation large vessels occlusion stroke were selected, and their data were merged for retrospective analysis. Patients were divided into the FR group and favorable prognosis group according to the functional prognosis. Risk factor analysis was conducted using multivariate logistic regression. A total of 1 581 patients were finally included, with 858 (48.9%) patients in favorable prognosis group and 926 (51.91%) patients in FR group. Among them, there were 939 males and 642 females, with a mean age of (65±12) years. Multivariate logistic regression analysis showed that National Institute of Health Stroke Scale (NIHSS) score (=1.089,95%:1.066-1.113), puncture to recanalization time (=0.756, 95%:0.586-0.971), age (=1.04,95%:1.029-1.051), serum glucose (=1.101,95%:1.062-1.143), systolic blood pressure (=1.005,95%:1.001-1.010), passes≥3(=1.941,95%:1.294-2.941)Alberta stroke program early CT (ASPECT) score (=0.919,95%:0.847-0.996), occlusion site (M1 segment of middle cerebral artery, =0.744,95%:0.565-0.980) and collateral circulation [(2 points, =0.757, 95%:0.581-0.985); (3-4 points, adjusted =0.640, 95%: 0.472-0.866)] were independent factors of FR. The incidence of FR in patients with large artery occlusion in anterior circulation who achieve satisfied reperfusion after endovascular treatment is high. Higher NIHSS score, longer puncture to recanalization time, older age, higher serum glucose and systolic blood pressure are risk factors, while lower ASPECTS, occlusion in cerebral middle M1 segment, better collateral circulation are protective factors.

摘要

分析前循环大动脉闭塞急诊血管内治疗后无效再通(FR)的相关因素。选取3项关于急性前循环大血管闭塞性卒中血管内治疗的研究,并对其数据进行合并以进行回顾性分析。根据功能预后将患者分为FR组和预后良好组。采用多因素logistic回归进行危险因素分析。最终纳入1581例患者,其中预后良好组858例(48.9%),FR组926例(51.91%)。其中男性939例,女性642例,平均年龄(65±12)岁。多因素logistic回归分析显示,美国国立卫生研究院卒中量表(NIHSS)评分(=1.089,95%置信区间:1.066 - 1.113)、穿刺至再通时间(=0.756,95%置信区间:0.586 - 0.971)、年龄(=1.04,95%置信区间:1.029 - 1.051)、血糖(=1.101,95%置信区间:1.062 - 1.143)、收缩压(=1.005,95%置信区间:1.001 - 1.010)、通过次数≥3(=1.941,95%置信区间:1.294 - 2.941)、阿尔伯塔卒中项目早期CT(ASPECT)评分(=0.919,95%置信区间:0.847 - 0.996)、闭塞部位(大脑中动脉M1段,=0.744,95%置信区间:0.565 - 0.980)和侧支循环[(2分,=0.757,95%置信区间:0.581 - 0.985);(3 - 4分,校正后=0.640,95%置信区间:0.472 - 0.866)]是FR的独立因素。前循环大动脉闭塞患者血管内治疗后实现满意再灌注时FR的发生率较高。较高的NIHSS评分、较长的穿刺至再通时间、较高的年龄、较高的血糖和收缩压是危险因素,而较低的ASPECTS评分、大脑中动脉M1段闭塞、较好的侧支循环是保护因素。

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