摘要：

目的: 探讨前循环和后循环串联病变患者血管再通治疗预后并筛查预后不良危险因素。方法: 纳入2019年4月至2022年8月在河北省石家庄市人民医院行血管再通治疗并实现血管再通的42例前循环和后循环串联病变患者，术后90 d采用改良Rankin量表(mRS)评价预后，单因素和多因素逐步法Logistic回归分析筛查预后不良危险因素。结果: 根据术后90 d mRS评分分为预后良好(≤ 2分)组(21例)和预后不良(> 2分)组(21例)，预后不良组入院时美国国立卫生研究院卒中量表(NIHSS)评分(Z=-2.916，P=0.004)、发病至血管再通时间(Z=-2.048，P=0.041)、取栓次数≥3次比例(χ²=4.725，P=0.030)和术后血肿型出血性转化比例(χ²=8.400，P=0.004)均高于预后良好组。Logistic回归分析显示，入院时NIHSS评分高(OR=12.457，95% CI：2.066~75.120；P=0.006)、取栓次数≥3次(OR=9.387，95% CI：1.222~72.140；P=0.031)和术后发生出血性转化(OR=7.237，95% CI：1.019~51.403；P=0.048)是前循环和后循环串联病变患者血管再通治疗预后不良的危险因素。结论: 入院时NIHSS评分较低、机械取栓次数 < 3次和术后未发生出血性转化的前循环和后循环串联病变患者血管再通治疗易获得良好预后。

关键词: 缺血性卒中, 串联病变(非MeSH词), 血管再通治疗(非MeSH词), 预后, 危险因素, Logistic模型

Abstract:

Objective: To analyze the prognosis and risk factors of the anterior and posterior circulation tandem lesions (TLs) patients after recanalization treatment. Methods: The general and clinical data of 42 patients with TLs who received recanalization treatment in Shijiazhuang People's Hospital from April 2019 to August 2022 were retrospectively collected.The prognosis of 90 d after surgery was evaluated by the modified Rankin Scale (mRS).Univariate and multivariate stepwise Logistic regression analyses were used to investigated the risk factors of poor prognosis of TLs. Results: According to mRS scores at the 90 d after surgery, the patients were divided into good prognosis group (mRS ≤ 2, n=21) and poor prognosis group (mRS > 2, n=21).The National Institutes of Health Stroke Scale (NIHSS) score at admission (Z=-2.916, P=0.004), time from onset to recanalization (Z=-2.048, P=0.041), mechanical thrombectomy times ≥ 3 (χ²=4.725, P=0.030) and the proportion of hematoma type hemorrhagic transformation (χ²=8.400, P=0.004) in the poor prognosis group were higher than those in good prognosis group.Logistic regression analysis showed that high NIHSS score at admission (OR=12.457, 95%CI: 2.066-75.120; P=0.006), mechanical thrombectomy times ≥ 3 (OR=9.387, 95%CI: 1.222-72.140; P=0.031) and postoperative hemorrhagic transformation (OR=7.237, 95%CI: 1.019-51.403; P=0.048) were risk factors of poor prognosis of TLs. Conclusions: Anterior and posterior circulation TLs patients with lower NHISS score at admission, mechanical thrombectomy times < 3 and without postoperative hemorrhagic transformation may have good prognosis.

Key words: Ischemic stroke, Tandem lesions(not in MeSH), Recanalization treatment(not in MeSH), Prognosis, Risk factors, Logistic models