高龄急性缺血性脑卒中病人行支架机械取栓治疗疗效及预后影响因素分析

doi:10.3969/j.issn.1003-9198.2021.05.011

摘要/Abstract

摘要： 目的评价血管内支架机械取栓术在高龄前循环急性缺血性脑卒中病人中的疗效和安全性。方法回顾性分析2018年2月至2019年9月因前循环急性缺血性脑卒中行机械支架取栓病人,最终纳入符合条件者90例,将年龄≥80岁的38例作为高龄组,年龄＜80岁的52例作为低龄组,统计2组病人的临床资料和围手术期相关数据,通过对比2组病人的血管再通率、NIHSS评分、90 d改良Rankin量表(mRS)评分来分析其疗效,通过对比症状性颅内出血风险和死亡率分析其安全性。采用多因素Logistic回归分析影响病人预后的因素。结果 2组病人从穿刺到血流再通时间、术后90 d mRS≤2分的比例差异具有统计学意义(P<0.05),其余指标差异均无统计学意义(P>0.05)。多因素回归分析显示年龄并不是影响预后的独立因素,血管完全再通[改良脑梗死溶栓血流分级(mTICI)达3级)]是影响预后的独立因素。结论行支架机械取栓术治疗的前循环急性缺血性脑卒中的高龄病人,在实现血管完全再通的情况下,也可以获得良好的临床效果。

关键词: 急性缺血性脑卒中, 高龄, 支架取栓, 预后

Abstract: Objective To evaluate the efficacy and safety of endovascular mechanical thrombectomy in the elderly patients with anterior circulation acute ischemic stroke. Methods A retrospective analysis of the patients who underwent the endovascular mechanical thrombectomy for acute ischemic stroke from February 2018 to September 2019 was conducted, and finally 90 cases were included.Thirty-eight patients aged ≥80 years were enrolled in the elderly group, and 52 patients aged <80 years were enrolled in the young age group.The baseline data and perioperative data of all patients were collected. The efficacy was analyzed by comparing modified Thrombolysis in Cerebral Infarction (mTICI) scores, and the scores of National Institutes of Health Stroke Scale(NIHSS), the Modified Rankin Scale(mRS). The safety was analyzed by comparing the risk of symptomatic cerebral hemorrhage and mortality. Multivariate Logistic regression analysis was used to analyze the independent influencing factors of the prognosis. Results There were significant differences in the time from puncture to vascular recanalization and 90-d prognosis between the two groups. Multivariate Logistic regression analysis showed that complete recanalization(mTICI3) was the positive factor for the prognosis. Conclusions Endovascular mechanical thrombectomy is effective for the elderly patients with acute ischemic stroke in the anterior circulation. In the case of complete recanalization of mTICI3, the elderly patients can also achieve good prognosis.

Key words: acute ischemic stroke, aged, mechanical thrombectomy, prognosis

中图分类号:

R 743.3

胡航佳, 周轩, 胡发云, 简能日, 高荣慧. 高龄急性缺血性脑卒中病人行支架机械取栓治疗疗效及预后影响因素分析[J]. 实用老年医学, 2021, 35(5): 475-478.

HU Hang-jia,ZHOU Xuan, JIAN Neng-ri, GAO Rong-hui, HU Fa-yun. Analysis of the efficacy and prognostic factors of mechanical thrombectomy in elderly patients with acute ischemic stroke[J]. Practical Geriatrics, 2021, 35(5): 475-478.

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