急性大血管闭塞性卒中早期成功再通后恶性脑水肿发生的影响因素分析

目的:观察急性大血管闭塞性卒中(acute large vascular occlusion stroke,ALVOS)早期成功再通后恶性脑水肿(malignant brain edema,MBE)的发生率、影响因素及对预后的影响。方法:回顾性分析2014年7月至2019年2月在皖南医学院第一附属医院行早期血管内治疗后血管成功再通的前循环ALVOS患者149例,年龄(68±11)岁,其中男性85例(57.0%)。收集入组患者的基线数据、围手术期参数及90 d预后信息。采用单因素和多因素回归分析探讨MBE与患者预后的关系以及引起MBE的危险因素。结果:149例患者中基线美国国立卫生研究院卒中量表评分16(13,20)分,基线Alberta卒中项目早期CT评分9(8,10)分,发病-置鞘时间(248.3±61.3)min,发病-再通时间(312.4±69.7)min。其中发生MBE患者23例(15.4%,23/149);发生MBE患者90 d功能独立90 d改良Rankin量表评分≤2分]率明显低于无MBE患者分别为17.4%(4/23)、61.1%(77/126),χ2=14.985,P<0.001],且90 d病死率明显高于无MBE患者分别为43.5%(10/23)、14.3%(18/126),χ2=10.861,P=0.003]。多因素分析结果显示MBE是影响90 d良好预后(调整OR=12.078,95%CI 1.934~75.443,P=0.008)和死亡(调整OR=4.146,95%CI 1.060~16.216,P=0.041)的独立危险因素;而脑侧支循环状态是影响前循环ALVOS患者早期血管内治疗血管再通后MBE发生的独立影响因素(2级侧支循环比0级侧支循环,调整OR=0.109,95%CI 0.021~0.563,P=0.008)。结论:MBE是影响ALVOS患者90 d良好预后和死亡的独立危险因素;对于ALVOS患者,即使早期血管内治疗后闭塞血管已获成功再通,但MBE仍不少见,而脑侧支循环状态是影响ALVOS患者早期血管内治疗血管再通后MBE发生的独立影响因素。

Risk factors of malignant brain edema after successful recanalization of acute large vascular occlusion stroke

Objective To observe the incidence,risk factors of malignant brain edema(MBE)and the influence of MBE on outcomes after early successful recanalization of acute large vascular occlusion stroke(ALVOS).Methods A total of 149 patients(age(68±11)years,male 85(57.0%))with ALVOS who underwent early endovascular treatment and achieved successful recanalization at the First Affiliated Hospital of Wannan Medical College from July 2014 to February 2019 were retrospectively analyzed.Baseline data,perioperative data,and 90-day prognostic information were collected from patients enrolled in the study.Univariate and multivariate analyses were used to explore the relationship between MBE and outcomes,and the risk factors of MBE.Results Among the 149 patients,baseline National Institutes of Health Stroke Scale score was 16(13,20),baseline Alberta Stroke Project early CT score was 9(8,10),the time of onset-to-puncture was(248.3±61.3)minutes,and the onset-to-recanalization time was(312.4±69.7)minutes.MBE occurred in 23 patients(15.4%,23/149).The 90-day favorable outcome(90-day modified Rankin Scale score≤2)in patients with MBE was significantly lower than those without MBE(17.4%(4/23)vs 61.1%(77/126),χ2=14.985,P<0.001),and the 90-day mortality in patients with MBE was significantly higher than those without MBE(43.5%(10/23)vs14.3%(18/126),χ2=10.861,P=0.003).MBE was shown to be an independent predictor of 90-day poor outcome(adjusted OR=12.078,95%CI 1.934-75.443,P=0.008)and death(adjusted OR=4.146,95%CI 1.060-16.216,P=0.041).Multivariate Logistic regression analysis showed that the collateral circulation status was related to the incidence of MBE in patients with ALVOS after successful recanalization(level 2 vs level 0,adjusted OR=0.109,95%CI 0.021-0.563,P=0.008).Conclusions MBE is an independent risk factor of ALVOS patients with poor outcome or death in 90 days.For patients with ALVOS,even if the occlusive vessels have been successfully recanalized after early endovascular treatment,MBE is still not uncommon.The collateral circulation state is an independent predictive factor of the development of MBE after recanalization by early endovascular treatment in patients with ALVOS.