【摘要】 目的探讨急性前循环缺血性卒中血管内治疗(EVT)的临床效果及危险因素,指导今后急诊取栓的临床工作。方法回顾分析吉大一院卒中中心2016年1月～2018年12月急性前循环闭塞且发病24 h内进行EVT的患者。主要结果是血管再通率,90 d mRS(0～2分是预后良好),72 h症状性颅内出血(s ICH),90 d死亡率。分析90 d不良功能预后的影响因素。结果 145例患者经急诊血管内介入治疗,其中128例(88. 3%)血管再通,s ICH 16例(11. 0%),90 d预后良好率67例(46. 2%),死亡26例(17. 9%)。老龄、高血压、糖尿病、全麻、串联/多血管病变、术前NIHSS评分高、s ICH、围手术期肺内感染是影响AIS前循环大血管闭塞血管内治疗患者90 d预后的危险因素。结论中国成熟卒中中心急性前循环卒中EVT的血管再通率很高、临床疗效很好,与发达的欧美国家一致。即使成熟的卒中中心急诊介入的死亡率仍然较高,手术风险较大。更多还原

【Abstract】 Objective To investigate clinical effectiveness outcome and risk factors of endovascular treatment for acute anterior circulation ischemic stroke to instruct emergency thrombectomy in future. Methods Between January 2016 and December 2018,stroke patients with acute anterior circulation occlusion and EVT within 24 h of symptom onset were retrospectively enrolled from stroke center in first hospital of Jilin university. The main outcomes were modified thrombolysis in cerebral ischemia( m TICI) assessing vascular recanalization,modified Rankin Scale( 0 ～ 2 as functional independence)at 90 days,symptomatic intracranial hemorrhage( s ICH) at 72 h,and death at 90 days. We also identified influence factors for poor functional outcomes at 90 days. Results Of the 145 patients received acute endovascular treatment,128( 88. 3%) patients had vascular recanalization. Symptomatic intracranial haemorrhage occurred in 16( 11%) patients. 67( 46. 2%) patients had functional independence at 90 days. Mortality rate at 90 days was 17. 9%( 26/145). Age,hypertension,diabetes mellitus,general anesthesia,tandem or multiple vascular lesions,high baseline NIHSS score,s ICH and perioperative pneumonia were risk factors of poor functional outcomes at 90 days of endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke secondary to large artery occlusion. Conclusion The vascular recanalization rate and clinical outcomes of endovascular treatment for acute anterior circulation ischemic stroke in Chinese experienced stroke center were consistent with those in developed European and American countries. Risk and mortality of emergency intervention are still high even at experienced stroke centers.更多还原