以球囊扩张为主导术式开通前循环急性颅内动脉粥样硬化性大血管闭塞疗效研究

目的探究跨过传统支架取栓而以球囊扩张为主导的血管内治疗方式是否具有安全性及有效性，分析机械取栓不良预后独立影响因素。方法回顾性分析山西白求恩医院2021年1月—2022年7月收治的79例急性前循环颅内动脉粥样硬化性大血管闭塞（ICAS-LVO）患者。根据不同主导开通方式分为球囊扩张组（34例），支架取栓组（45例），采用单因素及多因素二元Logistic回归分析探讨影响机械取栓预后的危险因素。结果总体血管再通率为88.6%（70/79），两组间再通率无显著差异（P>0.05）；支架主导组行球囊扩张比例为51.1%（23/45）；支架主导组M1段闭塞比例高于球囊扩张组（P<0.05）；球扩主导组再通2周后美国国立卫生研究院卒中量表（NIHSS）评分低于支架组（P<0.05）；两组间90 d功能独立比例、症状性颅内出血率、90 d病死率无显著差异（均P>0.05）。两组间性别、吸烟史、高血压病、高脂血症、糖尿病、术前静脉溶栓比例、支架置入比例无显著差异（均P>0.05）；两组间年龄、入院NIHSS评分、入院Alberta卒中项目早期计算机断层扫描评分（ASPECTS）、穿刺至再通时间无显著差异（均P>0.05）。入院时高NIHSS评分（优势比1.119，95%置信区间1.020～1.226，P=0.017）是机械取栓预后不良的独立危险因素。结论对于急性前循环ICAS-LVO患者，以球囊扩张为主导的血管内治疗方式是安全且有效的，术前NIHSS评分高会增加取栓术后不良转归风险。

Objective To explore the safety and efficacy of endovascular therapy dominated by balloon dilation rather than traditional stent thrombectomy. To analyze the independent influencing factors that lead to poor prognosis in patients with mechanical thrombectomy. Methods The clinical data of 79 patients with acute anterior circulation intracranial atherosclerotic large vessel occlusion（ICAS-LVO） admitted to The Third Hospital of Shanxi Medical University from January 2021 to July 2022 were analyzed retrospectively. According to different dominant opening methods, it was divided into balloon dilation group(34 cases) and stent thrombectomy group(45 cases). The risk factors affecting the prognosis of mechanical thrombectomy were explored by univariate and multivariate Logistic regression analysis. Results The overall vascular recanalization rate was 88.6%(70/79), and there was no significant difference in the proportion of recanalization between the groups(P>0.05). The proportion of balloon dilation in the stent dominant group was 51.1%(23/45). The proportion of M1 occlusion in the stent dominant group was higher than that in the balloon dilation group(P<0.05). The National Institute of Health Stroke Scale(NIHSS) score was lower than that in the stent thrombectomy group after 2 weeks of recanalization in the bulbous expansion group(P<0.05). There were no significant differences in the proportion of 90-d functional independence, symptomatic intracranial hemorrhage rate and 90-day mortality rate between the two groups(all P>0.05) . There were no significant differences in gender, smoking history, hypertension, hyperlipidemia, diabetes, preoperative intravenous thrombolysis, and stenting between the two groups(all P>0.05). There were no significant differences in age, admission NIHSS score, admission Alberta Stroke Program Early Computer Tomography Score(ASPECTS), and puncture-to-recanalization time between the two groups(all P>0.05). High NIHSS score on admission（odds ratio=1.119，95% confidence interval=1.020-1.226，P：0.017） were independent risk factors for poor prognosis for mechanical thrombectomy. Conclusions For patients with acute anterior circulation ICAS-LVO, balloon dilation-led endovascular therapy is safe and effective. High NIHSS scores increase the risk of adverse outcomes after embolectomy.