摘要：

目的: 筛查急性大动脉闭塞性缺血性卒中患者Solitaire支架多模式血管内治疗后首次再通的影响因素。方法: 纳入2020年1月至2022年6月于广西壮族自治区钦州市第一人民医院行Solitaire支架多模式血管内治疗的100例急性大动脉闭塞性缺血性卒中患者, 术后即刻采用改良脑梗死溶栓血流分级评估血管再通, 术前和术后24 h采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度、Alberta脑卒中计划早期CT评分(ASPECT)评估脑缺血程度, 术后90 d采用改良Rankin量表(mRS)评估神经功能预后; 采用单因素和多因素Logistic回归分析筛查首次再通的影响因素。结果: 共100例患者分为首次再通组(50例)和非首次再通组(50例)。Logistic回归分析显示, 大脑中动脉闭塞(OR = 0.233, 95%CI: 0.133 ~ 0.446;P = 0.015)、侧支代偿分级高(OR = 0.342, 95%CI: 0.203 ~ 0.538;P = 0.024)、术后24 h ASPECT评分增加(OR = 0.223, 95%CI: 0.078 ~ 0.707;P = 0.000)、术后90 d mRS评分减少(OR = 0.539, 95%CI: 0.194 ~ 0.884;P = 0.002)是Solitaire支架多模式血管内治疗后首次再通的保护因素; 而取栓次数增多(OR = 3.347, 95%CI: 1.118 ~ 5.576;P = 0.002)、发病至再通时间延长(OR = 4.997, 95%CI: 1.798 ~ 14.947;P = 0.009)、术后24 h NIHSS评分增加(OR = 3.038, 95%CI: 2.173 ~ 4.587;P = 0.000)是Solitaire支架多模式血管内治疗后未首次再通的危险因素。结论: Solitaire支架多模式血管内治疗后首次再通受闭塞部位、侧支代偿分级、取栓次数、发病至再通时间、术后24 h NIHSS和ASPECT评分、术后90 d mRS评分的影响, 临床实践中针对这些影响因素调整干预措施, 对提高临床疗效具有重要意义。

关键词: 缺血性卒中, 动脉闭塞性疾病, 支架, 危险因素, Logistic模型

Abstract:

Objective: To screen the influencing factors for first recanalization in patients with acute large artery occlusive cerebral infarction after Solitaire stent multi-mode endovascular treatment. Methods: The 100 patients with acute large artery occlusive cerebral infarction who received Solitaire stent multi-mode endovascular treatment in The First People's Hospital of Qinzhou from January 2020 to June 2022 were enrolled. The modified Thrombolysis in Cerebral Infarction (mTICI) was used to evaluate the recanalization. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of neurological deficits, and the Alberta Stroke Program Early CT Score (ASPECT) was used to evaluate degree of cerebral ischemia before and 24 h after surgery. The modified Rankin Scale (mRS) was used to evaluate the neurological functional prognosis. Univariate and multivariate Logistic regression analyses were conducted to screen the influencing factors for the first recanalization. Results: A total of 100 patients were divided into the first recanalization group (n = 50) and the non-first recanalization group (n = 50) according to whether they reached the mTICI blood flow grading standard (mTICI ≥ 2b). Logistic regression analysis showed that middle cerebral artery occlusion (OR = 0.233, 95%CI: 0.133-0.446; P = 0.015), more collateral circulation compensation (OR = 0.342, 95%CI: 0.203-0.538; P = 0.024), the ASPECT score increased 24 h after surgery (OR = 0.223, 95%CI: 0.078-0.707; P = 0.000), the mRS score decreased 90 d after surgery (OR = 0.539, 95%CI: 0.194-0.884; P = 0.002) were protective factors for the first recanalization after Solitaire stent multi-mode endovascular treatment. The frequency of thrombectomy increased (OR = 3.347, 95%CI: 1.118-5.576; P = 0.002), prolonged time from onset to recanalization (OR = 4.997, 95%CI: 1.798-14.947; P = 0.009), the NIHSS score increased 24 h after the surgery (OR = 3.038, 95%CI: 2.173-4.587; P = 0.000) were risk factors for the non-first recanalization after Solitaire stent multi-mode endovascular treatment. Conclusions: The first recanalization after Solitaire stent multi-mode endovascular treatment is affected by multiple factors. During the clinical diagnosis and treatment process, adjusting the intervention and treatment measures according to the relevant influencing factors is of great significance for improving the clinical efficacy.

Key words: Ischemic stroke, Arterial occlusive diseases, Stents, Risk factors, Logistic models