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_田伟.pdf

安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）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田伟，张泰民，高岩，杨章超，杨华，马文群作者单位：邯郸市中心医院神经外一科，河北 邯郸056006基金项目：邯郸市科学技术研究与发展项目（19422083009-2）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（3.420.28）分、（3.050.22）分、（2.630.17）分和BATMAN评分分别为（8.240.71）分、（7.130.63）分、（5.290.42）分均高于机械取栓前（1.310.36）分、（0.870.21）分、（0.520.17）分和（4.781.12）分、（3.360.87）分、（2.09 0.54）分（P0.05）；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（P0.05）；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（P0.05）；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（P0.05）；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（P0.05）；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）（P0.05）。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。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Effect of carotid artery stenosis on the circulatory state of the medial cranial branch after mechanical thrombus removalTIAN Wei,ZHANG Taimin,GAO Yan,YANG Zhangchao,YANG Hua,MA WenqunAuthor Affiliation:Department of Neurosurgery,Handan Central Hospital,Handan,Hebei 056006,ChinaAbstract：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 were compared 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 score were 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(3.420.28)score vs.(1.310.36)score,moderate stenosis(3.050.22)score vs.(0.870.21)score,severe stenosis and occlusion groups(2.630.17)score vs.(0.520.17)score and BATMAN scores(8.240.71)score vs.(4.781.12)score,(7.130.63)score vs.(3.360.87)score,and(5.290.42)score vs.(2.090.54)score were higher after mechanical embolization(P0.05);and the ASTIN/SIR and BATMAN scores before and after mechanical embolization in the severe stenosis and occlusion group were all lower than those in the moderate stenosis and mild stenosis groups,and all of the moderate stenosis group were lower than those of the mild stenosis group(P0.05).In Spearmans correlation analysis,the degree of carotid stenosis was negatively correlated with ASTIN/SIR and BATMAN scores before and after mechanical embolization(P0.05);in univariate analysis,the degree of carotid stenosis was significantly correlated with the status of intracranial collateral circulation and prognosis(P0.05).At 90 d follow-up,临床医学引用本文：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.DOI：10.3969/j.issn.1009-6469.2023.07.021.1368安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul，27（7）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 the mild stenosis group(P0.05);in the KM curve analysis,the 90-d survival rate 55.56%(10/18)in the severe stenosis and occlusion group was lower than that in the moderate stenosis group 89.74%(35/39)and the mild stenosis group 95.65%(22/23)(P0.05).Conclusion 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 and targeted 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.Key words：Stroke;Brain infarction;Carotid artery stenosis;Mechanical thrombus removal;Medial cranial branch circulation state;Prognosis急性缺血性脑卒中（acute ischemic stroke，AIS）属于临床常见急性脑血管疾病，多见于中老年人群，据统计，我国AIS发病率高达250/10万，严重威胁居民生活质量及生命安全1-2。目前，Solitaire AB支架机械取栓治疗AIS具