颈内动脉闭塞患者预后相关因素研究

doi:10.3969/j.issn.1000-8535.2024.03.006

广州医药 ›› 2024, Vol. 55 ›› Issue (3): 255-261.DOI: 10.3969/j.issn.1000-8535.2024.03.006

颈内动脉闭塞患者预后相关因素研究

韦英秀, 蒙喜斯, 崔伟, 彭定天, 李奕铮, 黄俏丽

广西医科大学附属武鸣医院神经内科（广西南宁 530199)

收稿日期:2023-09-05 出版日期:2024-03-20 发布日期:2024-04-12

Prognostic factors for the patients with internal carotid artery occlusion

WEI Yingxiu, MENG Xisi, CUI Wei, PENG Dingtian, LI Yizheng, HUANG Qiaoli

Department of Neurology Ⅱ,Wuming Hospital of Guangxi Medical University,Nanning 530199,China

Received:2023-09-05 Online:2024-03-20 Published:2024-04-12

摘要/Abstract

摘要： 目的探讨影响颈内动脉闭塞（ICAO）患者预后的相关因素,为临床改善ICAO患者预后提供理论依据。方法回顾性分析2017—2022年广西医科大学附属武鸣医院因ICAO入住神经内科的131例患者,根据ICAO发病时间分为急性颈内动脉闭塞（AICAO）和慢性颈内动脉闭塞（CICAO）,根据预后的不同,分为预后良好和预后不良组,比较两组的基本信息（性别、年龄等）、既往病史（包括高血压、糖尿病、冠心病等）、发病时神经功能损害程度（美国国立卫生研究院卒中神经功能缺损评分NIHSS评分）、侧支循环代偿评分、介入手术开通治疗、出血转化之间的差异,分析影响患者预后的相关因素。结果 CICAO患者总体预后良好,AICAO预后良好组患者发病时NIHSS评分<6分、侧支循环代偿良好比例高于预后不良组,而出血转化率低于预后不良组,组间比较差异均有统计学意义（P<0.05）。二分类Logistic回归分析显示,发病时NIHSS评分、侧支循环代偿评分、介入手术开通治疗、出血转化、次全闭塞对AICAO预后影响有统计学意义（P<0.05）。两组间的基本信息、既往病史、介入手术开通治疗等比较差异无统计学意义（P>0.05）。结论 CIACO较AICAO总体预后良好,发病时NIHSS评分<6分、侧支循环代偿良好、无出血转化是IACO预后良好的相关因素。发病时NIHSS评分高、侧支循环代偿不良、出血转化是ACAO预后不良的危险因素

关键词: 颈内动脉闭塞, 侧支循环代偿评分, NIHSS评分, 闭塞颈内动脉再通, 出血转化

Abstract: Objective To evaluate the prognostic significance of a group of clinical indices in the patients with internal carotid artery occlusion（ICAO）. Methods From 2017 to 2022,a total of 131 patients with ICAO were enrolled．All eligible patients were divided into acute ICAO（AICAO）and chronic ICAO groups（CICAO）,which were subdivided into good and poor prognosis groups．A respective analysis was performed to identify a practical profile for the outcome prediction of the patients with ICAO. Results The overall prognosis of CIACO was good．The proportion of NIHSS score < 6 in AICAO group with good prognosis and good collateral circulation compensation was significantly higher than that in poor prognosis group,while bleeding conversion was lower than that in poor prognosis group,with statistical significance（P<0.05）．Dichotomous logistic regression analysis showed that the prognostic effects of NIHSS score,collateral circulatory compensation score,interventional initiation,hemorrhagic transformation,and subtotal occlusion on the prognosis of AICAO were statistically significant．There were no significant differences in basic information,past medical history,interventional operation between the two groups（P>0.05）. Conclusions The patients with CICAO have a better prognosis than those with AICAO．NIHSS score < 6,good collateral circulation and no-hemorrhagic transformation may have strong prognostic relevance to ICAO．High NIHSS score,poor collateral circulation and hemorrhagic transformation at the time of onset are risk factors for poor prognosis of ACAO ．

Key words: internal carotid artery occlusion, compensation score, NIHSS score, interventional operation, hemorrhagic transformation

韦英秀, 蒙喜斯, 崔伟, 彭定天, 李奕铮, 黄俏丽. 颈内动脉闭塞患者预后相关因素研究[J]. 广州医药, 2024, 55(3): 255-261.

WEI Yingxiu, MENG Xisi, CUI Wei, PENG Dingtian, LI Yizheng, HUANG Qiaoli. Prognostic factors for the patients with internal carotid artery occlusion[J]. Guangzhou Medical Journal, 2024, 55(3): 255-261.

参考文献

[1] 张川,吴冠瑾,冯静静,等,慢性颈内动脉闭塞患者功能磁共振成像与脑白质高信号对脑梗死的风险预测[J].中华老年心脑血管病杂志,2022,24(3):293-297.
[2] MEYER F B,SUNDT T M JR,PIEPGRAS D G,et al.Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits[J].Ann Surg,1986,203(1):82-89.
[3] KLIJN C J,KAPPELLE L J,ALGRA A,et al.Outcome in patients with symptomatic occlusion of the internal carotid artery or intracranial arterial lesions:A meta-analysis of the role of baseline characteristics and type of antithrombotic treatment[J].Cerebrovasc Dis,2001,12(3):228-234.
[4] POWERS W J,CLARKE W R,GRUBB R L Jr,et al.Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia:The Carotid Occlusion Surgery Study randomized trial[J].JAMA,2011,306(18):1983-1992.
[5] 姜卫剑,焦力群,李天晓,等.慢性颈内动脉闭塞再通治疗中国专家共识[J].中华介入放射学电子杂志,2019,7(1):1-6.
[6] BENE V,BRAD O,HORV TH D,et al.Surgery of acute occlusion of the extracranial internal carotid artery-a meta-analysis[J].Vasa,2020,49(1):6-16.
[7] BERKHEMER O A,FRANSEN P S,BUMER D,et al.A randomized trail of inreaarterial reatment for actue ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
[8] MIZOWAKI T,FUJITA A,INOUE S,et al.Outcome and effect of endovascular treatment in stroke associated with acute extracranial internal carotid artery occlusion:Single-center experience in Japan[J].J Stroke Cerebrovasc Dis,2020,29(7):104824.
[9] ZHANG Y,ZHANG L,ZHANG Y,et al.Endovascular recanalization for acute internal carotid artery terminus occlusion:A subgroup analysis from the direct-MT trial[J].Neurosurgery,2022,91(4):596-603.
[10] FISCHER U,MONO M L,SCHROTH G,et al.Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery[J].Eur J Neurol,2013,20(7):1017-1024,e87.
[11] 刘欢颜,华扬,贾凌云,等.急性期和慢性期颈内动脉闭塞患者侧支循环类型对颅内血流灌注的影响[J].中国脑血管病杂志,2022,19(6):396-404.
[12] HAUSE S,OLDAG A,BREJA A,et,al.Acute symptomatic extracranial internal carotid occlusion - natural course and clinical impact[J].Vasa,2020,49(1):31-38.
[13] HONG J H,KANG J,JANG M U,et al.Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2014,23(8):2183-2189.
[14] THOMPSON J E,AUSTIN D J,PATMAN R D.Carotid endarterectomy for cerebrovascular insufficiency:Long-term results in 592 patients followed up to thirteen years[J].Surg Clin N Am,1986,66(2):233-253.
[15] 夏金超,汪勇锋,张坤,等.有症状的慢性颈内动脉闭塞患者开通术的临床初步疗效[J].中华放射学杂志,2021,55(5):490-494.
[16] 季蕾,蒋颖,岳春贤,等.颈动脉支架植入术治疗颈内动脉次全闭塞的临床研究[J].临床神经病学杂志,2017,30(5):355-357.

颈内动脉闭塞患者预后相关因素研究

Prognostic factors for the patients with internal carotid artery occlusion

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