| 蔡明,李瑞,陶春蓉,等.急性基底动脉闭塞机械取栓术后无效再通的危险因素分析[J].中国临床保健杂志,2024,27(6):790-794. |
| 急性基底动脉闭塞机械取栓术后无效再通的危险因素分析 |
| Risk factors for futile recanalization after mechanical thrombectomy for acute basilar artery occlusion |
| 投稿时间：2024-06-04 |
| DOI：10.3969/J.issn.1672-6790.2024.06.015 |
| 中文关键词: 栓子清除术 基底动脉 动脉闭塞性疾病 危险因素 |
| 英文关键词: Embolectomy Basilar artery Arterial occlusive diseases Risk factors 〖FL |
| 基金项目: |
| 作者 | 单位 | E-mail | | 蔡明 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 李瑞 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 陶春蓉 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 荆孝忠 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 罗聪 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 江夏 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 陈敏 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 张可意 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 高飞扬 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn | | 胡伟 | 安徽医科大学附属省立医院神经内科,合肥 230001 | andinghu@ustc.edu.cn |
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| 中文摘要: |
| 目的 探讨急性基底动脉闭塞(BAO)机械取栓术后无效再通的影响因素,并建立临床预测模型,为后循环急性脑梗死患者的管理提供依据。方法 随机对照研究(ATTENTION)的回顾性分析。研究于2021年2月至2022年1月在我国36家医学中心开展。选取ATTENTION研究中行机械取栓术治疗的患者204例,根据3个月时是否发生无效再通分为有效再通组(72例)和无效再通组(132例)。采用多因素logistic回归分析急性BAO患者机械取栓术后无效再通的独立危险因素。通过受试者工作特征(ROC)曲线、Hosmer-Lemeshow检验(HL检验)和决策曲线(DCA曲线)评价Nomogram模型的效能。结果 与有效再通组相比,无效再通组患者年龄更高、穿刺至再通时间(PTR)更长、基线美国国立卫生研究院卒中量表(NIHSS)评分更高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示年龄、基线NIHSS评分及PTR是急性BAO机械取栓术后无效再通的独立预测因素。最终模型中的变量包括年龄、基线NIHSS评分、PTR及白细胞计数(WBC)。内部验证结果显示,模型预测无效再通的风险的曲线下面积(AUC)为0.755。当Nomogram模型预测急性BAO患者机械取栓治疗后无效再通的风险阈值＞0.28,Nomogram模型可提供临床净收益。结论 年龄、基线NIHSS评分和PTR均为急性BAO患者行机械取栓治疗后无效再通的独立预测因素；研究构建的Nomogram预测模型具有较好的预测价值。 |
| 英文摘要: |
| Objective To explore the influencing factors for futile recanalization after mechanical thrombectomy for acute basilar artery occlusion (BAO),and establish a clinical prediction model,so as to provide evidence for the management of patients with posterior circulation acute cerebral infarction.Methods This study was a retrospective analysis of the Acute Basilar Artery Occlusion Endovascular Treatment Randomized Controlled Trial (ATTENTION).The study was conducted from February 2021 to January 2022 at 36 medical centers in China.Two hundred and four patients who underwent mechanical thrombectomy in ATTENTION trial were recruited and divided into the effective recanalization group (n=72) and the futile recanalization group (n=132) according to whether futile recanalization occurred at 3 months.Multivariate logistic regression was used to analyze the independent risk factors for futile recanalization after mechanical thrombectomy in patients with acute BAO.The efficiency of the model was evaluated by receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test (HL test) and decision curve analysis (DCA curve).Results Compared with the effective recanalization group,patients in the futile recanalization group were older,and had longer puncture to vascular recanalization time (PTR),as well as higher baseline NIHSS score,with significant differences (P<0.05).According to multivariate logistic regression analysis,age,baseline NIHSS score and PTR were the independent predictors of futile recanalization after mechanical thrombectomy for acute BAO.Variables in the final model included age,baseline NIHSS score,PTR,and white blood cell count (WBC).As revealed by internal validation results,the area under the curve (AUC) of the model in predicting the risk of futile recanalization was 0.755.When the risk threshold of the model in predicting the risk of futile recanalization after mechanical thrombectomy in acute BAO patients was>0.28,the model provided a clinical net benefit.Conclusions Age,baseline NIHSS score,and PTR are the independent predictors of futile recanalization after mechanical thrombectomy in patients with acute BAO,and the Nomogram model established in this study has good predictive value. |
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