文章摘要
赵静 ，石翀 ，吴群 ，万志荣 ，罗彬 ，姚昕璐 ，徐亚辉 ，王培福 ，李继来.大动脉粥样硬化与心源性栓塞性急性大血管闭塞患者血管内治疗对比研究[J].神经损伤功能重建,2023,(6):329-333
大动脉粥样硬化与心源性栓塞性急性大血管闭塞患者血管内治疗对比研究
Comparative Study of Endovascular Treatment in Patients with Acute Large Vessel OcclusionInduced by Large Artery Atherosclerosis or Cardioembolism
  
DOI：
中文关键词: 急性大血管闭塞  大动脉粥样硬化  心源性栓塞  血管内治
英文关键词: large vessel occlusion  large artery atherosclerosis  cardioembolism  endovascular treatment
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作者单位
赵静a ，石翀b ，吴群a ，万志荣a ，罗彬a ，姚昕璐a ，徐亚辉a ，王培福a ，李继来a 航天中心医院a.神 经内科，b.中医科 
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中文摘要:
      目的：探讨大动脉粥样硬化（LAA）与心源性栓塞（CE）2种不同机制所致急性大血管闭塞（ALVO）患 者的临床特点，并比较血管内治疗（EVT）的疗效及预后。方法：回顾性纳入2018年5月至2022年7月在航 天中心医院国家高级卒中中心接受EVT的ALVO患者。根据卒中病因分型将患者分为LAA组和CE组， 应用mTICI分级评价血管再通情况、改良Rankin量表评分（mRS）评价患者90 d预后，统计术后72 h颅内 出血转化（HT）发生率及90 d死亡率，评价EVT的安全性。比较2组患者的临床特征、手术疗效及预后， 并探讨不良预后的独立危险因素。结果：共纳入 184 例患者，其中 LAA 组 164 例（89.1%），CE 组 20 例 （10.9%）。与CE组相比，LAA组年龄更小（P＜0.001），基线美国国立卫生研究院卒中量表（NIHSS）评分 更低（P=0.024），基线格拉斯哥昏迷（GCS）评分更高（P=0.037）。2组既往心房颤动（P＜0.001）、饮酒史（P= 0.004）及D-二聚体（P=0.008）及尿酸（P=0.038）水平均存在统计学差异。2组在穿刺至再通时间、术后成功 再通、取栓次数及取栓方式等手术相关操作均无统计学差异。LAA组患者90 d预后良好的比例显著高于 CE组（38.4% vs 10%，P=0.012），死亡率较CE组低（13.4% vs 35%，P=0.03），差异有统计学意义，但2组颅内 HT无统计学差异（P=0.522）。多因素Logistic回归分析显示，年龄和基线NIHSS评分是不良预后的独立危 险因素。结论：LAA型缺血性卒中患者接受EVT治疗较CE型预后更好、死亡率更低；年龄、基线NIHSS评 分与不良预后独立相关。
英文摘要:
      To discuss the differences in clinical characteristics of patients with acute large vessel occlusion (ALVO) due to large artery atherosclerosis (LAA) or cardioembolism (CE), and to compare the efficacy of endovascular treatment (EVT). Methods: All patients with ALVO who received EVT between May 2018 and July 2022 in the Aerospace Center Hospital National Advanced Stroke Center were included in this retrospective study. Patients were classified into the LAA group and CE group according to the TOAST classification system. Modified Thrombolysis in Cerebral Infarction (mTICI) score was used to evaluate the revascularization status; modified Rankin Scale score (mRS) at 90-day was used to evaluate prognosis; intracranial hemorrhage transformation (HT) within 72 hours after EVT and 90-day mortality were used to evaluate the safety of the surgery. We compared the clinical characteristics, therapeutic efficacy, and the prognosis of two groups after EVT, and explored the independent risk factors for poor prognosis. Results: A total of 184 patients were enrolled in this study; 164 patients were placed in the LAA group (89.1%) and 20 in the CE group (10.9%). Compared to patients in the CE group, those in the LAA group had a significantly younger age (P<0.001), lower baseline National Institutes of Health Stroke Scale (NIHSS) scores (P=0.024), and higher Glasgow coma scale (GCS) scores (P= 0.037). There were statistically significant differences in history of atrial fibrillation (P<0.001), drinking (P= 0.004), D-dimer level (P=0.008), and uric acid level (P=0.038). There were no significant differences in puncture to reperfusion time, recanalization rate, times of thrombectomy and thrombectomy method. Compared to patients in the CE group, those in the LAA group had a significantly higher good prognosis rate (38.4% vs. 10%, P=0.012), lower mortality rate (13.4% vs. 35%, P=0.03), but there was no significant difference in intracranial HT (P=0.522). Multivariate logistic regression analysis showed that age and baseline NIHSS scores were independent risk factors for poor prognosis. Conclusion: LAA ischemic stroke patients have better prognosis and lower mortality than CE patients after EVT. Age and baseline NIHSS scores are independently associated with poor prognosis.
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