急性前循环大血管闭塞性卒中Solitaire支架取栓术后预后危险因素分析

目的 探讨急性前循环大血管闭塞性卒中机械取栓术后预后不良或死亡的危险因素。方法 回顾性分析2015年1月至2018年2月Solitaire支架取栓术治疗的176例急性前循环大血管闭塞性卒中的临床资料，采用多因素 Logistic回归分析检验危险因素。术后3个月，采用改良Rankin量表（mRS）评分评估预后，0~2分为预后良好，3~6分为预后不良，6分为死亡。结果 176例中，预后不良79例，预后良好97例；死亡41例，存活135例。多因素Logistic回归分析显示，年龄>80岁、高血压病史、颈内动脉闭塞、取栓次数>3次、再通不良、术后再闭塞及术后症状性脑出血为预后不良的独立危险因素（P<0.05）；高血压病史、侧支不良、取栓次数>3次、发病至成功再通时间长、术后症状性脑出血及术后系统性并发症为死亡的独立危险因素（P<0.05）。结论 急性前循环大血管闭塞性卒中Solitaire支架取栓术后预后的危险因素很多，强调尽早进行取栓术并减少取栓次数和术后并发症有利于改善病人预后；此外，应重视血压对于病人预后的影响。

Risk factors related to poor prognosis and death in patients with acute anterior circulation ischemic stroke after mechanical thrombectomy by Solitaire stents

Objective To analyze the risk factors related to poor outcomes and deaths in patients with acute anterior circulation ischemic stroke (AACIS) undergoing mechanical thrombectomy (MT). Methods The clinical data of 176 patients with AACIS undergoing MT by Solitaire stents from January, 2015 to February, 2018 were analyzed retrospectively. The risk factors related to poor outcomes and deaths were statistically evaluated by multivariate logistic regression analysis. Results Of 176 patients, 97 (55.11%) had good prognosis and 79 (44.89%) including 41 dead patients and 38 survivors had poor prognosis. The multivariate logistic analysis showed that the independent risk factors of the poor prognosis included the patient’s age>80 years, history of hypertensive blood pressure, internal carotid artery occlusion, times of thrombectomy>3, unsuccessful vascularecanalization, and postoperative reocclusion and sympomatic cerebral hemorrhage (P<0.05), and independent risk factors of death included history of hypertensive blood pressure, poor collateral circulation, times of thrombectomy>3, long time from the attack to vascularecanalization, postoperative sympomatic cerebral hemorrhage and systemic complications (P<0.05). Conclusions The decrease in times of thrombectomy and rate of postoperative sympomatic cerebral hemorrhage occurrence can improve clinical prognoses in the patients with AACIS, in whom we should pay more attention to their history of hypertensive blood pressure, which may lead to poor outcomes.