摘要
目的探讨急性基底动脉近端或中段闭塞行Solitaire^(TM)支架再通后3个月预后与术前侧支循环代偿之间的关系。方法对天坛医院2014-01—2014-12期间33例因基底动脉近端或中段急性闭塞行SolitaireTM支架机械再通患者的资料进行回顾性分析,根据再通术前脑血管造影(DSA)所示侧支循环代偿情况进行分级(Ⅰ-Ⅳ级),将患者侧支循环代偿程度分级,术前NIHSS评分,闭塞血管再通时间,有无高血压、糖尿病、高脂血症,是否合并基础狭窄、合并溶栓、合并支架植入等与SolitaireTM支架机械再通3个月预后情况〔分为预后良好(MRS评分0~2)和预后差(MRS评分3~6分)两组〕分别进行单因素分析,并将两组间比较P<0.10的因素与3个月预后情况行多因素Logistics回归分析,筛选出影响3个月预后的独立风险因素。结果与SolitaireTM支架机械再通3个月预后差的基底动脉近端或中段急性闭塞患者比较,预后良好的患者侧支循环代偿程度较好(H=13.6,P=0.001)、再通术前NIHSS评分低(t=-3.315,P=0.004);其他相关因素两组间比较差异无统计学意义(均P>0.05)。其中,血管代偿程度分级、术前NIHSS评分和合并高血压病(P=0.066)等三种因素P<0.10,对这三种因素进行多因素Logistics回归分析显示,代偿程度分级(OR=7.536,P=0.017)和术前NIHSS评分(OR=1.150,P=0.039)是影响患者预后的独立风险因素。结论术前NIHSS评分、血管代偿程度分级是评估近端或中段急性基底动脉闭塞患者3个月预后的独立风险因素,而且术前血管代偿程度分级评价近端或中段急性基底动脉闭塞患者3个月预后的灵敏度更高。
Objective To evaluate the relationship between the prognosis of endovascular mechanical thrombectomy with the Solitaire stent in patients with proximal or middle basilar artery occlusion and preoperative collateral circulation compensation. Methods Retrospective analysis was adopted among 33 cases with proximal or middle basilar artery occlusion from Jan 2014 to Dec 2014 in Tiantan hospital. Mechanical recanalization was performed by using the Solitaire device. According to the compensatory situation of collateral circulation showed by digital subtraction angiography （DSA）before recanalization,the patients were classified as grade Ⅰ-Ⅳ. Compensatory degree grading,preoperative NIHSS score,vascular reperfusion time,hypertension,diabetes mellitus,hyperlipidemia,atherosclerotic plaque,thrombolysis,intracranial stent and prognosis [good prognosis （MRS score was 0-2）,poor prognosis （MRS score was 3-6）]3 months after recanalization by Solitaire stent were analyzed by single factor analysis. Then the factors of P 〈 0.10 were selected to carry out multi-factor logistic regression analysis and independent risk factors of prognosis after endovascular mechanical thrombectomy with the Solitaire device for basilar artery occlusion were screened. Results Compared with the patients with poor prognosis 3 months after recanalization by Solitaire stent,the degree of compensatory collateral circulation was better in patients with good prognosis （H = 13.6,P = 0.001 ）and NIHSS score was lower before the recanalization （t=-3.315,P =0.004）. There were no statistical differences of other related factors between the two groups （P 〉0.05,respectively）and P 〈0.10 in the factors of compensatory grade,NIHSS score and＆amp;nbsp;hypertention. Multi-factor logistic regression analysis showed compensatory degree grading （OR =7.536,P =0.017）and preoperative NIHSS score （OR =1.150,P =0.039）were independent risk factors. Conclusions Preoperative NIHSS score and compensatory degree grading of the basilar artery were independent risk factors for evaluating the 3 months prognosis of patients with acute proximal or middle basilar artery occlusion （ABAO）and preoperative compensatory grading was more sensitive.
出处
《中国神经免疫学和神经病学杂志》
CAS
2016年第4期261-266,共6页
Chinese Journal of Neuroimmunology and Neurology
作者简介
通讯作者：高峰，Email：zhanghongbin1233@163．com
