| 田伟,张泰民,高岩,等.颈动脉狭窄程度对机械取栓后颅内侧支循环状态的影响研究[J].安徽医药,2023,27(7):1368-1372. |
| 颈动脉狭窄程度对机械取栓后颅内侧支循环状态的影响研究 |
| Effect of carotid artery stenosis on the circulatory state of the medial cranial branch after mechanical thrombus removal |
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| DOI：10.3969/j.issn.1009-6469.2023.07.021 |
| 中文关键词: 卒中 脑梗死 颈动脉狭窄 机械取栓 颅内侧支循环状态 预后情况 |
| 英文关键词: Stroke Brain infarction Carotid artery stenosis Mechanical thrombus removal Medial cranial branch circula tion state Prognosis |
| 基金项目:邯郸市科学技术研究与发展项目( 19422083009-2) |
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| 中文摘要: |
| 目的探究颈动脉狭窄程度对机械取栓后颅内侧支循环状态的影响。方法选取邯郸市中心医院 2019年 1月至 2020年 12月 80例急性缺血性脑卒中( AIS)病人作为研究对象，根据颈动脉狭窄程度分为轻度狭窄组( n=23)、中度狭窄组( n= 39)、重度狭窄及闭塞组( n=18)，均行机械取栓，比较三组临床资料、机械取栓前后颅内侧支循环状态［神经介入和治疗神经放射学会 /介入放射学会( ASTIN/SIR)、基底动脉 CT血管造影( BATMAN)评分］，分析颈动脉狭窄程度与 ASTIN/SIR、BATMAN评分相关性，随访 90 d，统计三组预后情况，评价颈动脉狭窄程度对颅内侧支循环状态、预后的影响，并采用 KM曲线进行生存分析。结果机械取栓后轻度狭窄组、中度狭窄组、重度狭窄及闭塞组 ASTIN/SIR评分分别为( 3.42±0.28)分、(3.05±0.22)分、(2.63±0.17)分和 BATMAN评分分别为( 8.24±0.71)分、(7.13±0.63)分、(5.29±0.42)分均高于机械取栓前( 1.31±0.36)分、(0.87±0.21)分、(0.52±0.17)分和( 4.78±1.12)分、(3.36±0.87)分、(2.09± 0.54)分( P<0.05)；且重度狭窄及闭塞组机械取栓前、机械取栓后 ASTIN/SIR、BATMAN评分均低于中度狭窄组、轻度狭窄组，中度狭窄组均低于轻度狭窄组( P<0.05)； Spearman相关性分析，颈动脉狭窄程度与机械取栓前、机械取栓后 ASTIN/SIR、BATMAN评分呈负相关( P<0.05)；单因素分析，颈动脉狭窄程度与颅内侧支循环状态、预后的显著相关( P<0.05)；随访 90 d，重度狭窄及闭塞组预后不良率 61.11%高于中度狭窄组 35.90%、轻度狭窄组 13.04%，中度狭窄组预后不良率高于轻度狭窄组( P<0.05)； KM曲线分析，重度狭窄及闭塞组 90 d生存率 55.56%(10/18)低于中度狭窄组 89.74%(35/39)、轻度狭窄组 95.65%(22/23)(P<0.05)。结论颈动脉狭窄程度对 AIS病人机械取栓后颅内侧支循环状态与预后均有重要影响，术前准确判断颈动脉狭窄程度并采取针对性治疗措施有利于改善颅内侧支循环状态，强化机械取栓效果，降低预后不良及死亡风险。 |
| 英文摘要: |
| Objective To explore the effect of carotid artery stenosis on the state of medial cranial branches after mechanical thrombus removal.Methods A total of 80 patients with acute ischemic stroke (AIS) in Handan Central Hospital from January 2019 to December 2020 were selected as the research objects. According to the degree of carotid artery stenosis, they were assigned into mild stenosis group (n=23), moderate stenosis group (n=39), and severe stenosis and occlusion group (n=18), all underwent mechanical thrombectomy. The clinical data of the 3 groups and the state of the medial cranial branch before and after mechanical thrombectomy werecompared [Society of Neurointervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASTIN/SIR), basilar artery CT angiography (BATMAN) score], the correlation between the degree of carotid artery stenosis and ASTIN/SIR, BATMAN scorewere analyzed, the patients were followed up for 90 days, the prognosis of the three groups was analyzed, the degree of carotid artery stenosis on intracranial collateral circulation status and prognosis was evaluated. KM curve was used for survival analysis.Results The ASTIN/SIR scores in the mild stenosis [(3.42±0.28)score vs. (1.31±0.36)score], moderate stenosis [(3.05±0.22)score vs. (0.87±0.21) score], severe stenosis and occlusion groups [(2.63±0.17)score vs. (0.52±0.17)score] and BATMAN scores [(8.24±0.71)score vs. (4.78± 1.12)score], [(7.13±0.63)score vs. (3.36±0.87)score], and [(5.29±0.42)score vs. (2.09±0.54)score] were higher after mechanical embolization (P<0.05); and the ASTIN/SIR and BATMAN scores before and after mechanical embolization in the severe stenosis and occlusiongroup were all lower than those in the moderate stenosis and mild stenosis groups, and all of the moderate stenosis group were lowerthan those of the mild stenosis group (P<0.05). In Spearman′s correlation analysis, the degree of carotid stenosis was negatively correlated with ASTIN/SIR and BATMAN scores before and after mechanical embolization (P<0.05); in univariate analysis, the degree of carotid stenosis was significantly correlated with the status of intracranial collateral circulation and prognosis (P<0.05). At 90 d follow-up,the poor prognosis rate (61.11%) in the severe stenosis and occlusion group was higher than that in the moderate stenosis group(35.90%) and the mild stenosis group (13.04%), and the poor prognosis rate in the moderate stenosis group was higher than that in themild stenosis group (P<0.05); in the KM curve analysis, the 90-d survival rate [55.56% (10/18)] in the severe stenosis and occlusiongroup was lower than that in the moderate stenosis group [89.74% (35/39)] and the mild stenosis group [95.65% (22/23)] (P<0.05).Con? clusion The degree of carotid artery stenosis has an important influence on the state and prognosis of the medial cranial branch circulation after mechanical thrombus removal in AIS patients. Preoperative accurate judgment of the degree of carotid artery stenosis andtargeted treatment measures are beneficial to improve the state of the medial cranial branch circulation, strengthen mechanical removal and reduce the risk of poor prognosis and death. |
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