后循环急性缺血性脑卒中患者经机械取栓完全复流后不良预后的影响因素分析

目的探索后循环急性缺血性脑卒中（PCS）患者经机械取栓并完全恢复前向血流后部分患者临床预后仍然不佳的影响因素。 方法连续纳入2017年1月至2020年9月于我院接受机械取栓治疗的PCS患者并进行回顾性分析。闭塞血管完全恢复前向血流定义为改良脑梗死溶栓血流分级（mTICI）达3级。90 d改良Rankin评分（mRS）> 2分则被定义为预后不良。将患者基线资料、治疗相关指标纳入多因素分析，并采用受试者工作特征曲线（ROC）来确定最佳界值。 结果共纳入39例经机械取栓治疗后完全恢复前向血流（mTICI 3级）的PCS患者。其中，预后不良患者共20例（51.3%）。采用逐步Logistic回归分析显示，入院时美国国立卫生研究院卒中量表（NIHSS）评分较高（OR = 1.21，95%CI = 1.037~1.414，P = 0.016）、后交通动脉（PcomA）未开放（OR = 0.052，95%CI = 0.005~0.557，P = 0.014）为90 d不良预后的独立预测因素。基于ROC曲线分析显示，入院时NIHSS评分曲线下面积为0.762，截断值为20分，敏感度为70.0%，特异度为84.2%。 结论入院时NIHSS评分高、后交通动脉未开放，是后循环急性缺血性脑卒中患者接受机械取栓治疗并完全恢复前向血流后临床预后仍不佳的相关因素。

Predictors of poor outcome despite complete reperfusion after mechanical thrombectomy of posterior circulation acute ischemic stroke

ObjectiveTo investigate the poor prognostic factors of posterior circulation stroke (PCS) after complete reperfusion by mechanical thrombectomy. Methods39 patients with PCS treated with mechanical thrombectomy (MT) from January 2017 to September 2020 were included and retrospectively analyzed. Complete reperfusion in occlusive vessels was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. 90 d modified Rankin score (mRS) > 2 was defined as a poor outcome. The baseline data and treatment-related indicators were included in the multivariate analysis, and the receiver operating characteristic (ROC) curve was used to determine the best cut-off value. Results39 patients with complete reperfusion (mTICI 3) were included in this study. Poor outcome was observed in 20 (51.3%) of these patients. Stepwise Logistic regression analysis showed that lower NIHSS score (OR = 1.21, 95%CI = 1.037-1.414, P = 0.016) and posterior communicating artery (PcomA) patency (OR = 0.052, 95%CI = 0.005-0.557, P = 0.014) were independent predictors of favourable 90 d outcome. Based on the analysis of ROC curve, the area under the curve of NIHSS score at admission was 0.762, cut-off value was 20, sensitivity was 70.0%, specificity was 84.2%. ConclusionsHigh NIHSS score and PcomA occlusion at admission are poor prognostic factors of PCS treated with mechanical thrombectomy after complete reperfusion.