作者：王磊1 ，张保朝2 ，高军2 ，温昌明2 ，刘义锋2 ，汪宁2 ，向远阳2 ，郑皓存2

单位：

1.453000河南省新乡市，新乡医学院研究生院　 2.473000河南省南阳市中心医院神经内科介入病区

Units：

1.Graduate School of Xinxiang Medical College, Xinxiang 453000, China 2.Department of Neurology Intervention, Nanyang Central Hospital, Nanyang 473000, China

关键词：

脑梗死；急性椎基底动脉闭塞；血管内治疗；无效再通；影响因素分析

Keywords：

Brain infarction; Acute vertebrobasilar artery occlusion; Endovascular treatment; Futile recanalization; Root cause analysis

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2024.00.078

Funds：

河南省科技发展计划项目（202102310079）

摘要：

目的　探讨急性椎基底动脉闭塞（AVBO）性脑梗死患者血管内治疗后无效再通的影响因素。方 法　回顾性选取2018年10月—2022年12月南阳市中心医院收治的行血管内治疗的AVBO性脑梗死患者196例为研究 对象。收集患者的临床资料，术后90 d采用改良Rankin量表（mRS）评分评估患者预后情况，并将其分为有效再通 （mRS评分≤3分）和无效再通（mRS评分＞3分）。采用ROC曲线分析中性粒细胞与淋巴细胞比值（NLR）、美国 国立卫生研究院卒中量表（NIHSS）评分、后循环Alberta卒中项目早期CT评分（pc-ASPECTS）、基底动脉CT血管成 像（BATMAN）评分、急性基底动脉闭塞血管造影侧支分级系统（ACGS-BAO）分级预测AVBO性脑梗死患者血管内 治疗后无效再通的最佳截断值；采用多因素Logistic回归分析探讨AVBO性脑梗死患者血管内治疗后无效再通的影响 因素。结果　196例AVBO性脑梗死患者中，无效再通110例（56.1%）。有效再通与无效再通者收缩压、有糖尿病史 者占比、NLR、NIHSS评分、pc-ASPECTS、BATMAN评分、ACGS-BAO分级比较，差异有统计学意义（P＜0.05）。 ROC曲线分析结果显示，NLR、NIHSS评分、pc-ASPECTS、BATMAN评分预测AVBO性脑梗死患者血管内治疗后 无效再通的最佳截断值为4.6、14.5分、6.5分、4.5分。多因素Logistic回归分析结果显示，糖尿病史〔OR=2.560， 95%CI（1.076～6.091）〕、NLR〔OR=1.064，95%CI（1.006～1.125）〕、NIHSS评分〔OR=4.043，95%CI （1.929～8.474）〕、pc-ASPECTS〔OR=0.715，95%CI（0.558～0.916）〕、ACGS-BAO分级〔OR=0.590，95%CI （0.426～0.816）〕是AVBO性脑梗死患者血管内治疗后无效再通的独立影响因素（P＜0.05）。结论　糖尿病史、 NLR、NIHSS评分、pc-ASPECTS、ACGS-BAO分级是AVBO性脑梗死患者血管内治疗后无效再通的独立影响因素。

Abstract：

Objective To investigate the influencing factors of futile recanalization after endovascular treatment in patients with acute vertebrobasilar artery occlusion (AVBO) cerebral infarction. Methods A total of 196 patients with AVBO cerebral infarction who underwent endovascular treatment in Nanyang Central Hospital from October 2018 to December 2022 were retrospectively selected as the research subjects. The clinical data of the patients were collected, at 90 days after surgery, the prognosis of patients was evaluated using the modified Rankin Scale (mRS) score, and divided into effective recanalization (mRS score ≤ 3 points) and futile recanalization (mRS score > 3 points) . ROC curve was used to investigate the optimal cut-off values of neutrophil-lymphocyte ratio (NLR) , National Institute of Health Stroke Scale (NIHSS) score, posterior circulation Alberta stroke program early CT score (pc-ASPECTS) , basilar artery on computed tomography angiography (BATMAN) score, and angiographic collateral grading system for basilar artery occlusion (ACGS-BAO) grading in predicting futile recanalization after endovascular treatment in patients with AVBO cerebral infarction. Multivariate Logistic regression analysis was used to explore the influencing factors of futile recanalization after endovascular treatment in patients with AVBO cerebral infarction. Results Among 196 patients with AVBO cerebral infarction, 110 (56.1%) had futile recanalization. There was statistically significant differences in systolic blood pressure, proportion of patients with diabetes history, NLR, NIHSS score, pc-ASPECTS, BATMAN score, and ACGS-BAO grading between patients with effective recanalization and patients with futile recanalization (P < 0.05) . ROC curve analysis showed that the optimal cut-off value of NLR, NIHSS score, pc-ASPECTS, BATMAN score in predicting futile recanalization after endovascular treatment in patients with AVBO cerebral infarction was 4.6, 14.5 points, 6.5 points, 4.5 points. Multivariate Logistic regression analysis showed that history of diabetes [OR=2.560, 95%CI (1.076-6.091) ] , NLR [OR=1.064, 95%CI (1.006-1.125) ] , NIHSS score [OR=4.043, 95%CI (1.929-8.474) ] , pc-ASPECTS [OR=0.715, 95%CI (0.558-0.916) ] , ACGS-BAO grading [OR=0.590, 95%CI (0.426-0.816) ] were the independent influencing factors of futile recanalization after endovascular treatment in patients with AVBO cerebral infarction (P < 0.05) . Conclusion The history of diabetes, NLR, NIHSS score, pc-ASPECTS, ACGS-BAO grading are the independent influencing factors of futile recanalization after endovascular treatment in patients with AVBO cerebral infarction.

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