支架取栓治疗急性大动脉闭塞性脑梗死预后的影响因素分析

目的 探讨支架取栓治疗急性大动脉闭塞性脑梗死患者预后的影响因素。方法 回顾分析连续收治的支架取栓治疗急性大动脉闭塞性脑梗死患者50例，采用术后90天改良Rankin（mRS）评分分为远期预后良好（mRS≤2）组29例和远期预后不良（mRS≥3）组21例。对两组患者基线资料（基础疾病、性别、年龄、术前ASPECT评分、术前NIHSS评分）、诊疗情况（发病至血管再通时间、责任闭塞动脉、侧支循环、取栓次数、复合再通方式）、诊疗结果（血管再通率、术后24小时NIHSS评分、颅内出血转化、死亡）等进行单因素对比，单因素对比差异有统计学意义的变量进行多因素Logistic回归分析以明确影响患者预后的独立因素。结果 两组在合并糖尿病、术前NIHSS评分、侧支循环、术后24小时NIHSS评分、责任闭塞动脉、血管再通率、术后1周颅内出血转化方面的差异有统计学意义（均P＜0.05），多因素Logistic回归分析结果显示：侧支循环、血管再通率、术后1周颅内出血转化、术后24小时NIHSS评分差异具有统计学意义（均P＜0.05）。结论 糖尿病、术前NIHSS评分、侧支循环、责任闭塞动脉、术后24小时 NIHSS评分、血管再通率、术后1周颅内出血转化是影响支架取栓治疗大动脉闭塞性脑梗死患者预后的因素，侧支循环代偿良好、血管再通率高、术后1周出血转化高、术后24小时 NIHSS评分恶化等是影响患者预后的独立因素。

Analysis of prognostic factors of mechanical thrombectomy in patients with acute aortic occlusive cerebral infarction

Objective To investigate prognostic factors of mechanical thrombectomy in the treatment of patients with acute aortic occlusive cerebral infarction.Methods A retrospective analysis was made on the prognosis of 50 patients with acute aortic occlusive cerebral infarction treated with mechanical thrombectomy.According to modified Rankin Scale Score(mRS)at 90 days postoperatively,the patients were divided into two groups,29 patients(mRS≤2)of good prognosis group and 21 patients(mRS≥3)of poor prognosis group.Single factor contrast was carried out on the baseline data(underlying diseases,age,gender,preoperative ASPECT score and preoperative NIHSS score),treatment status(onset to revascularization time,responsible occlusive artery,collateral circulation,number of thrombectomy,methods of vascular recanalization)and treatment results(revascularization rate,postoperative 24 h NIHSS score,intracranial hemorrhagic transformation,death),and the variables with significant differences were further analyzed by multivariate logistic regression analysis in order to identify independent factors that influence patient prognosis.Results There were significant differences in combined diabetes,preoperative NIHSS score,collateral circulation,postoperative 24 h NIHSS score,responsible occlusive artery,revascularization rate,and intracranial hemorrhagic transformation at one week postoperatively(all P<0.05).Multivariate Logistic regression analysis showed that there were statistically significant differences in collateral circulation,revascularization rate,hemorrhagic transformation at one week postoperatively and postoperative 24 h NIHSS score(all P<0.05).Conclusion Diabetes,preoperative NIHSS score,collateral circulation,responsible occlusive artery,postoperative 24 h NIHSS score,revascularization rate,and intracranial hemorrhagic transformation at one week postoperatively are the factors affecting the prognosis of patients.Good compensation of collateral circulation,high revascularization rate,high intracranial hemorrhagic transformation at one week postoperatively and deterioration in postoperative 24 h NIHSS score are independent factors affecting the prognosis of patients.