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投稿时间:2023-01-23 网络发布日期:2023-03-20
投稿时间:2023-01-23 网络发布日期:2023-03-20
中文摘要: 目的 探讨急诊支架植入或单纯球囊成形对颅内动脉粥样硬化狭窄相关急性缺血性脑卒中患者转归的影响。方法 回顾性纳入2019年1月至2022年6月在南京鼓楼医院卒中中心或南京江北医院接受急诊血管内治疗的颅内动脉粥样硬化狭窄相关急性缺血性脑卒中患者160例。根据患者血管成形方式分为单纯球囊成形组(n=72)和支架植入组(n=88)。比较两组人口统计学资料、手术相关指标、围手术期并发症、7天内血管再狭窄率及术后90 d转归情况。通过logistic回归分析影响患者转归的因素。结果 90 d转归良好(改良Rankin量表评分≤2分)89例(55.6%),死亡13例(8.1%)。与单球囊扩张组相比,支架置入组有更高的90 d转归良好率[67.0%(59/88) vs 41.6%(30/72),χ2=19.711,P<0.01]和更低的90 d血管再狭窄率[10.2%(9/88) vs 36.1%(26/72),P<0.01]。两组的颅内出血发生率[18.2%(16/88) vs 19.4%(14/72),χ2=0.041,P=0.839]以及病死率[8.0%(7/88) vs 8.3%(6/72),χ2=0.008,P=0.931]比较差异无统计学意义。多变量logistic回归分析提示,急诊支架置入是患者术后90 d转归良好的独立保护因素(OR=1.353,95%CI:1.089~3.485,P<0.01)。结论 相比于球囊成形术,急诊支架植入可以改善颅内动脉粥样硬化狭窄相关急性缺血性脑卒中患者90 d预后,降低90 d内再狭窄率,且不增加围手术期出血风险。
Abstract:Objective To investigate the effect of emergency stent implantation or balloon angioplasty on the outcome of patients with acute ischemic stroke related to intracranial atherosclerotic stenosis. Methods A total of 160 patients with acute ischemic stroke related to intracranial atherosclerotic stenosis who received emergency endovascular treatment in Nanjing Drum Tower Hospital Stroke Center or Nanjing Jiangbei Hospital from January 2019 to June 2022 were retrospectively included. The patients were divided into simple balloon angioplasty group (n=72) and stent implantation group (n=88) according to the angioplasty method. The demographic data, surgical related indicators, perioperative complications, the rate of vascular restenosis within 7 d and the outcome at 90 d after operation were compared between the two groups. Logistic regression was used to analyze the factors affecting the outcome of patients. Results After 90 days, 89 cases (55.6%) had good outcome (improved Rankin scale score≤2), and 13 cases (8.1%) died. Compared with the simple balloon dilation group, the stent implantation group had a higher 90-day good outcome rate[67.0% (59/88) vs 41.6% (30/72), χ2=19.711, P<0.01] and lower 90-day restenosis rate [10.2% (9/88) vs 36.1% (26/72), P<0.01]. There was no significant difference in the incidence of intracranial hemorrhage [18.2% (16/88) vs 19.4% (14/72), χ2=0.041, P=0.839] and mortality[8.0% (7/88) vs 8.3% (6/72), χ2=0.008, P=0.931] between two groups. Multivariate logistic regression analysis showed that emergency stent placement was an independent protective factor for patients with good prognosis 90 d after surgery (OR=1.353, 95%CI: 1.089-3.485, P<0.01). Conclusion Compared with balloon angioplasty, emergency stent implantation can improve the 90-day prognosis of patients with acute ischemic stroke related to intracranial atherosclerotic stenosis, reduce the rate of restenosis within 90 d, and do not increase the risk of perioperative bleeding.
keywords: Stroke Cerebral ischemia Endovascular treatment Reversion Balloon forming Stent implantation Atherosclerotic stenosis
文章编号: 中图分类号:R743.3 文献标志码:A
基金项目:国家自然科学基金项目(82103196)
引用文本:
成宜舜,栾丽芹,张曦,等.急诊支架植入或单纯球囊成形对颅内动脉粥样硬化狭窄相关急性缺血性脑卒中患者转归的影响[J].中国临床研究,2023,36(3):325-328.
成宜舜,栾丽芹,张曦,等.急诊支架植入或单纯球囊成形对颅内动脉粥样硬化狭窄相关急性缺血性脑卒中患者转归的影响[J].中国临床研究,2023,36(3):325-328.