目的 探讨影响发病24h内急性椎-基底动脉闭塞(AVBAO)行血管内治疗(EVT)预后的相关因素。方法 回顾性连续纳入2020年10月至2023年9月河南省人民医院脑血管病科收治的发病24h内接受EVT治疗的AVBAO患者。收集患者的一般资料和临床资料，包括年龄、性别、卒中相关危险因素(高脂血症、高血压病、糖尿病、心房颤动、冠心病、吸烟、既往卒中)、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前改良Rankin量表(mRS)评分、起病形式、术前静脉溶栓、后循环Alberta卒中项目早期CT评分(pc-ASPECTS)、基底动脉CT血管成像(BATMAN)评分、闭塞部位(椎动脉颅内段、基底动脉)及手术相关资料，包括治疗方式[直接导管抽吸取栓和(或)支架取栓、球囊扩张、支架置入等;首选支架置入或球囊扩张为直接血管成形术，若取栓术后血流不能维持需进一步行球囊扩张和(或)支架置入则为补救血管成形术]、发病至穿刺时间(OPT)、穿刺至血管再通时间(PRT)、术后即刻改良脑梗死溶栓(mTICI)分级(以mTICI分级2b或3级为血管成功再通)、围手术期并发症[术中栓子逃逸、术中再闭塞、术中夹层、术后3 d内出血转化和术后3 d内症状性颅内出血(sICH)]。以术后90d mRS评分评估患者预后，mRS评分≤3分为预后良好，mRS评分＞3分为预后不良。纳入单因素分析结果中P＜0。1的指标，采用向后剔除法筛选变量并进行多因素Logistic回归分析，对发病24h内AVBAO患者行EVT预后的影响因素进行分析。结果 共纳入接受EVT的AVBAO患者149例，其中预后良好患者79例，预后不良患者70例，术后即刻血管成功再通患者145例，发生围手术期并发症34例，死亡32例。(1)单因素分析结果显示，与预后不良患者相比，预后良好患者的术前NIHSS评分[16。0(12。0，23。0)分比24。5(16。8，31。3)分，Z=-4。280，P＜0。01]和术前mRS评分[4(4，4)分比5(4，5)分，Z=-4。711，P＜0。01]均更低，糖尿病患者比例更低[15。2％(12/79)比35。7％(25/70)，x2=8。376，P=0。004]，且预后良好患者术后3d内出血转化发生率[7。6％(6/79)比 25。7％(18/70)，x2=-0。246，P=0。003]与 sICH 发生率[1。3％(1/79)比14。3％(10/70)，x2=-0。249，P=0。002]均低于预后不良患者。(2)将年龄、高脂血症、糖尿病、术前NIHSS评分、术前mRS评分、术后3 d内出血转化及sICH纳入多因素Logistic回归分析，结果显示，高脂血症(OR=2。433，95％CI:1。088～5。441)、糖尿病(OR=2。797，95％CI:1。168～6。701)、术前高 NIHSS 评分(OR=3。715，95％CI:1。684～8。195)、术后 3 d 内 sICH(OR=19。681，95％CI:1。984～195。192)是发病24 h内AVBAO患者接受EVT预后不良的独立危险因素(均P＜0。05)。结论 高脂血症、糖尿病、术前高NIHSS评分和术后3d内sICH是发病24h内接受EVT的AVBAO患者预后不良的独立危险因素。
Analysis of factors influencing the prognosis of endovascular treatment of acute vertebrobasilar occlusion within 24 hours of onset of disease
Objective To investigate the factors affecting the prognosis of endovascular treatment(EVT)for acute vertebrobasilar artery occlusion(AVBAO)within 24 h of onset of disease.Methods General and clinical data of AVBAO patients admitted to the Department of Cerebrovascular Diseases,Henan Provincial People's Hospital who received EVT within 24h of onset from October 2020 to September 2023 were retrospectively and consecutively included,including age,sex,stroke-related risk factors(hyperlipidemia,hypertension,diabetes mellitus,atrial fibrillation,coronary artery disease,smoking,and previous stroke),preoperative National Institutes of Health stroke scale(NIHSS)score,preoperative modified Rankin scale(mRS)score,form of onset,preoperative intravenous thrombolysis,posterior circulation Alberta stroke program early CT score(pc-ASPECTS),basilar artery on computed tomography angiography(BATMAN)score,site of occlusion(intracranial segment of vertebral artery,basilar artery),and surgical procedure(direct aspiration and/or stent-retrieval,balloon dilatation,stenting,etc.First-line stenting or balloon dilatation is direct angioplasty;if blood flow cannot be maintained after thrombectomy,further balloon dilatation and/or stenting is required as remedial angioplasty),onset-to-puncture time,puncture-to-recanalization time,and postprocedure immediate modified thrombolysis in cerebral infarction(mTICI)grading(successful recanalization was defined as mTICI grading 2b or 3),and perioperative complications(intraprocedural thrombus migration,intraprocedural reocclusion,intraprocedural dissection,postoperative hemorrhagic transformation within 3 d,and symptomatic intracranial hemorrhage[sICH]).Patient prognosis was assessed by mRS score at 90 d postoperatively.The mRS score≤3 was classified as good prognosis,and mRS score＞3 was classified as poor prognosis.Indicators with P＜0.1 in the results of univariate analysis were included,and variables were screened by backward elimination and subjected to multifactorial Logistic regression analysis to analyze the factors influencing the prognosis of AVBAO patients undergoing EVT within 24 h of the onset of the disease.Results A total of 149 AVBAO patients who underwent EVT were included,including 79 patients with good prognosis,70 patients with poor prognosis,145 patients with successful revascularization,34 patients with perioperative complications,and 32 patients with death.(1)The results of univariate analysis showed that compared with patients with poor prognosis,patients with good prognosis had lower preoperative NIHSS scores(16.0[12.0,23.0]vs.24.5[16.8,31.3],Z=-4.280,P＜0.01)and preoperative mRS scores(4[4,4]vs.5[4,5],Z=-4.711,P＜0.01),a lower percentage of diabetes mellitus(15.2％[12/79]vs.35.7％[25/70],x2=8.376,P=0.004),and the incidence of postoperative hemorrhagic transformation within 3d(7.6％[6/79]vs.25.7％[18/70],x2=-0.246,P=0.003)and the incidence of sICH(1.3％[1/79]vs.14.3％[10/70],x2=-0.249,P=0.002)were significantly lower in patients with good prognosis than that in patients with poor prognosis.(2)Age,hyperlipidemia,diabetes mellitus,preoperative NIHSS score,preoperative mRS score,postoperative hemorrhagic transformation within 3 d and sICH were included in multifactorial Logistic regression analysis,which showed that hyperlipidemia(OR,2.433,95％CI 1.088-5.441),diabetes mellitus(OR,2.797,95％CI 1.168-6.701),high preoperative NIHSS score(OR,3.715,95％CI 1.684-8.195),and postoperative sICH within 3 d(OR,19.681,95％CI 1.984-195.192)were the independent risk factors for poor prognosis of patients with AVBAO who underwent EVT within 24 h of onset(all P＜0.05).Conclusion Hyperlipidemia,diabetes mellitus,high preoperative NIHSS score,and postoperative sICH within 3 d were independent risk factors for poor prognosis in AVBAO patients who underwent EVT within 24 h of onset.
万方数据
维普
