急性缺血性脑卒中血管内治疗常见不良事件和预后分析

目的 探讨急性缺血性脑卒中患者血管内治疗术中及术后常见不良事件的发生率、发生原因及其对预后的影响.方法 回顾性连续纳入2013年9月至2018年5月在我院接受血管内治疗的急性缺血性脑卒中患者513例,根据术中及术后是否发生不良事件分为研究组(发生1种或几种不良事件,230例)和对照组(无不良事件,283例).分析入组患者不良事件的发生率和原因,对比分析两组患者基线资料、血管成功再通率、良好预后率、病死率等,并采用多因素logistic回归分析探讨不良事件与临床预后的关系.结果 513例患者不良事件总发生率为44.8％(230/513),包括任何类型颅内出血(22.0％,113例)、症状性颅内出血(9.6％,49例)、进展性缺血性脑卒中(23.4％,120例)、新血管流域栓塞(6.2％,32例)、动脉夹层(1.4％,7例)、支架内血栓形成(1.9％,10例)和血管再闭塞(4.5％,23例)等.导致不良事件的原因有再灌注损伤、无效再灌注、机械损伤(支架、导管、导丝)和药物等.与对照组相比,研究组患者年龄偏大(t=2.298,P<0.05),男性患者占比低(χ2=9.614,P<0.01),术前美国国立卫生研究院卒中量表(NIHSS)评分较高、美国神经介入和治疗神经放射学会/介入放射学会侧支循环分级系统(ASITN/SIRs)评分较低(Z=34.378、13.311,P均<0.01).研究组取栓次数多于对照组(Z=22.677,P<0.01),但血管成功再通(改良脑梗死溶栓2b/3级)率和术后90 d预后良好(改良Rankin量表评分为0～2分)率均低于对照组(χ2=19.903、180.191,P均<0.01),术后90 d病死率高于对照组(χ2=52.818,P<0.01).多因素logistic回归分析表明,症状性颅内出血和进展性缺血性脑卒中是急性缺血性脑卒中患者血管内治疗后预后不良的独立危险因素(P均<0.01).结论 急性缺血性脑卒中血管内治疗术中及术后不良事件会影响90 d预后,症状性颅内出血和进展性缺血性脑卒中是预后不良的独立预测因素.

Analysis of common adverse events and prognosis of endovascular treatment for acute ischemic stroke

Objective To explore the incidence and causes of common adverse events of acute ischemic stroke patients during and after endovascular treatment, and to analyze their effects on prognosis. Methods A total of 513 consecutive patients with acute ischemic stroke, who received endovascular treatment in our hospital from Sep. 2013 to May 2018, were included retrospectively. The patients with 1 or more adverse events (n=230) were included in study group, and those without adverse events (n=283) were included in control group. The incidence and etiology of adverse events were analyzed in both groups. The baseline data, successful recanalization rate, good prognosis rate and mortality in the two groups were compared and analyzed. The relationship between adverse events and clinical prognosis was explored by multivariate logistic regression analysis. Results The total incidence of adverse events was 44.8% (230/513), including intracranial hemorrhage (22.0%, 113 cases), symptomatic intracranial hemorrhage (9.6%, 49 cases), progressive ischemic stroke (23.4%, 120 cases), new territory embolism (6.2%, 32 cases), arterial dissection (1.4%, 7 cases), stent thrombosis (1.9%, 10 cases), reocclusion (4.5%, 23 cases) and so on. Reperfusion injury, futile reperfusion, mechanical injury (caused by stent, catheter or wire) and drugs were responsible for the development of the adverse events. Compared with the control group, the age and the pre-procedural score of National Institutes of Health stroke scale (NIHSS) were significantly higher (t=2.298, P<0.05, and Z=34.378, P<0.01), and the proportion of males and the pre-procedural score of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale (ASITN/SIRs) were significantly lower (χ²=9.614, P<0.01, and Z=13.311, P<0.01) in the study group. Although more passes were significantly performed to achieve successful recanalization in the study group compared with the control group (Z=22.677, P<0.05), the rates of successful recanalization (modified thrombolysis in cerebral infarction graded 2b/3) and good prognosis (modified Rankin scale scored 0-2) 90 d after operation were significantly lower in the study group (χ²=19.903 and 180.191, both P<0.01), but with a significantly higher mortality 90 d after operation (χ²=52.818, P<0.01). The results of the multivariate logistic regression analysis indicated that symptomatic intracranial hemorrhage and progressive ischemic stroke were independent risk factors of poor prognosis of acute ischemic stroke patients after endovascular treatment (both P<0.01). Conclusion Adverse events of acute ischemic stroke patients during and after endovascular treatment can affect the 90-d prognosis. Symptomatic intracranial hemorrhage and progressive ischemic stroke are independent predictors of poor prognosis.