摘要： 目的 探讨急性颈内动脉狭窄性串联病变颅内动脉机械取栓术同期行急诊颈动脉支架成形术（CAS）的有效性和安全性。方法 选择2015年1月至2019年12月福建医科大学附属漳州市医院收治的79例急性颈内动脉狭窄性串联病变患者，均采用“半前向法”伴或不伴保护技术行血管内治疗，根据是否急诊行颈动脉支架成形术分为CAS组（47例）和无CAS组（32例），对比分析两组手术相关指标［包括术前Alberta脑卒中计划早期CT评分（ASPECTS）、串联病变部位、侧支代偿、血流再灌注、穿刺至血管再通时间、C型臂CT渗出表现、异位栓塞］以及临床预后指标（包括出血性转化、责任血管再闭塞、术后90 d预后良好率和病死率），单因素和多因素前进法Logistic回归分析筛查急性颈内动脉狭窄性串联病变患者术后90 d预后不良影响因素。结果 共计79例患者术后即刻改良脑梗死溶栓血流分级≥2b级，血管再通率达100%，CAS组与无CAS组术前ASPECTS评分（t=- 0.170，P=0.865）、串联病变部位（Z=5.907，P=0.091）、侧支代偿（t=- 0.900，P=0.368）、穿刺至血管再通时间（t=0.182，P=0.856）、C型臂CT有渗出表现（Z=- 0.171，P=0.864）、异位栓塞发生率（χ²=0.872，P=0.350），以及出血性转化（χ²=1.670，P=0.434）、责任血管再闭塞（χ²=0.000，P=1.000）、术后90 d预后良好率（χ²=2.149，P=0.143）和病死率（χ²=0.150，P=0.699）组间差异均无统计学意义。Logistic回归分析显示，年龄增大（OR=1.078，95% CI： 1.011~1.148； P=0.021）和C型臂CT有渗出表现（OR=5.163，95% CI： 1.633~16.326； P=0.005）是急性颈内动脉狭窄性串联病变患者术后90 d预后不良的危险因素。结论 急性颈内动脉狭窄性串联病变采用“半前向法”伴或不伴保护技术在机械取栓后根据责任颈内动脉狭窄程度和C型臂CT脑实质渗出情况决策是否急诊行颈动脉支架成形术安全、可行，值得临床推广。

关键词: 颈动脉狭窄, 血栓切除术, 支架, 危险因素, Logistic模型

Abstract: Objective To investigate the efficacy and safety of emergent carotid artery stenting (CAS) after intracranial artery mechanical thrombectomy for acute internal carotid artery (ICA) stenosis related tandem lesions. Methods A total of 79 patients with acute ICA stenosis related tandem lesions admitted to the Advanced Stroke Center of Zhangzhou Hospital affiliated to Fujian Medical University from January 2015 to December 2019 were selected. All patients underwent urgent endovascular therapy with "half" anterograde approach with or without usage of embolic prevention device (EPD) technology, and divided into CAS group (n = 47) and non -CAS group (n = 32) according to whether CAS was performed in emergency. Compared and analysed the 2 groups of surgical related indexes [including the preoperative Alberta Stroke Program Early CT Score (ASPECTS), the occlusion site of tandem lesions, the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System (ASITN/SIR ACG), puncture-to-reperfusion time, leakage on C-arm CT, incidence of distal embolism], and the clinical prognostic indicators [including the incidence of symptomatic intracranial hemorrhage (sICH), culprit artery reocclusion rate, postoperative 90-d favorable outcome rate and mortality]. Univariate and multivariate forward Logistic regression were used to analysis the influencing factors of postoperative 90-d poor prognosis in acute ICA stenosis related tanchem lesions. Results All 79 patients had immediate postoperative mTICI grading ≥ 2b, the vascular recanalization rate was 100%. There was no statistically significant differences in the preoperative ASPECTS (t = - 0.170,P = 0.865), the occlusion site of tandem lesions (Z = 5.907,P = 0.091), the ASITN/SIR ACG (t = - 0.900，P = 0.368） , puncture-to-reperfusion time (t = 0.182,P = 0.856), leakage on C-arm CT (Z = - 0.171,P = 0.864), incidence of distal embolism (χ² = 0.872,P = 0.350), the incidence of sICH (χ² = 1.670,P = 0.434), the culprit artery re - occlusion rate (χ² = 0.000,P = 1.000), postoperative 90-d favorable outcome rate (χ² = 2.149,P = 0.143) and the mortality (χ² = 0.150,P = 0.699) between CAS group and non - CAS group. Logistic regression analysis showed that increasing age (OR = 1.078, 95%CI: 1.011-1.148;P = 0.021), leakage on C - arm CT (OR = 5.163, 95%CI: 1.633-16.326;P = 0.005) were risk factors for postoperaive 90 -d poor outcomes of the patients with acute carotid atherosclerotic stenosis related tandem lesions. Conclusions For patients with acute ICA stenosis related tandem lesions used "half" anterograde approach with or without usage of EPD technology, the decision of emergent CAS after mechanical thrombectomy was made according to the stenosis degree of ICA and leakage on C-arm CT. This strategy is safe and feasible, and has the potential of clinical promotion.

Key words: Carotid stenosis, Thrombectomy, Stents, Risk factors, Logistic models