急性脑梗死支架取栓术后蛛网膜下腔出血影响因素

目的探讨急性脑梗死患者接受支架取栓术后发生蛛网膜下腔出血(SAH)的影响因素。方法回顾性分析88例经支架取栓治疗的急性大脑中动脉(MCA)闭塞患者,对比分析术后发生SAH(SAH组)与未发生SAH者(无SAH组)的差异。结果 88例均成功经支架取栓。术后14例出现SAH,74例无SAH。2组患者性别、年龄、基础疾病、入院时美国国立卫生研究院卒中量表(NIHSS)评分等一般资料,术中所用取栓支架长度及直径、血管痉挛发生率、行挽救性血管成形术比例、术后改良脑梗死溶栓(mTICI)分级差异均无统计学意义(P均0.05);SAH组取栓次数、支架释放于M2段内长度、MCA顶-底距离(D-TB)均高于无SAH组(P均0.05)。结论 MCA纡曲、多次取栓、M2段取栓及支架释放于M2段较长可能增加急性脑梗死患者支架取栓术后SAH风险。

Impact factors of subarachnoid hemorrhage after stent embolectomy in acute ischemic stroke

Objective To explore the impact factors of subarachnoid hemorrhage (SAH) after stent embolectomy in acute ischemic stroke. Methods Data of 88 patients with middle cerebral artery (MCA) occlusion who underwent stent embolectomy were retrospectively analyzed. The baseline characteristics and clinical data were compared between patients with SAH (SAH group) and non-SAH (non-SAH group) after operation. Results Stent mechanical thrombectomy was successfully performed in all 88 patients. SAH occurred in 14 cases, while 74 cases were found non-SAH after operation. No significant difference of the baseline characteristics of age, sex, National Institute of Health stroke scale (NIHSS) score, etc, the diameters or length of stent, incidence of vasospasm, the incidence of angioplasty nor modified thrombolysis in cerebral infarction (mTICI) was found between 2 groups (all P>0.05). The number of thrombectomy attempts, stent position along the M2 segment and the top-to-bottom distance (D-TB) of MCA in SAH group were significantly higher than those in non-SAH group (all P<0.05). Conclusion Tortuous MCA, multiple thrombectomy, M2 segment thrombectomy and stent releasing in M2 segment may increase the risk of SAH after stent thrombectomy in patients with acute cerebral infarction.