Page 48 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第2期
·194 · Journal of Nanjing Medical University（Natural Sciences） 2022年2月

·临床医学·

老年房颤患者前循环急性缺血性脑卒中机械取栓预后分析

焦锦程 ，郦明芳 ，刘 圣 ，崔 畅 ，程弘毅 ，贾振宇 ，施海彬 ，陈明龙 1*
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南京医科大学第一附属医院心血管内科，放射介入科，江苏 南京 210029
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［摘 要］ 目的：评估因前循环大血管闭塞导致的急性缺血性脑卒中合并房颤的老年患者取栓治疗的临床结局及影响因素。
方法：2019 年 1 月—2021 年 7 月，前循环大血管闭塞且合并房颤的老年患者（≥80 岁）被纳入研究。主要终点为 90 d 改良
Rankin 评分（modified Rankin scale，mRS）。次要终点包括全因死亡率、血管再通等级（modified thrombolysis in cerebral infarc⁃
tion scale，mTICI）和颅内出血转化。采用多因素Logistic回归分析影响临床预后的因素。结果：最终纳入74例患者。良好预后
（90 d mRS 0~2分）率为21.6%，血流良好再通（mTICI 2b⁃3级）比例为77%，全因死亡率为36.4%，颅内出血转化率为35.1%。多因
素Logistic回归分析显示，非阵发性心房颤动（OR=18.35，95%CI：1.98~169.77，P=0.010）、基线美国国立卫生研究院卒中量表（NI⁃
HSS）评分（OR=1.42，95%CI：1.15~1.75，P < 0.001）、总流程时长（OR=1.01，95%CI：1.00~1.02，P=0.030）是老年房颤患者机械取栓
预后的独立危险因素。结论：老年房颤患者前循环急性缺血性脑卒中时，如合并基线NIHSS评分高和/或非阵发性房颤时，选择取
栓治疗要更慎重。也需进一步提高老年房颤患者的抗凝率预防脑卒中。
［关键词］ 急性缺血性脑卒中；心房颤动；老年人；机械取栓
［中图分类号］ R541.75 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）02⁃194⁃06
doi：10.7655/NYDXBNS20220208

Prognosis after mechanical thrombectomy in elderly atrial fibrillation patients with anterior⁃

circulation acute ischemic stroke
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JIAO Jincheng ，LI Mingfang ，LIU Sheng ，CUI Chang ，CHENG Hongyi ，JIA Zhenyu ，SHI Haibin ，CHEN
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Minglong
Division of Cardiology，Division of Interventional Radiology，the First Affiliated Hospital of Nanjing Medical
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University，Nanjing 210029，China
［Abstract］ Objective：To evaluate the clinical outcomes after mechanical thrombectomy（MT）in elderly atrial fibrillation（AF）
patients with anterior⁃circulation large vessel occlusion（LVO）⁃related acute ischemic stroke（AIS）. Methods：Between January 2019
and July 2021，consecutive elderly（≥80 year）AF patients who received MT due to anterior⁃circulation stroke were enrolled. The
primary outcome was modified Rankin scale（mRS）score at 90 days. Secondary outcomes included all ⁃ cause mortality，the
recanalization status after MT（assessed using modified thrombolysis in cerebral infarction scale，mTICI）and any intracranial
hemorrhage（ICH）. A multivariable logistic regression model was performed to identify predictors of the functional outcome. Results：A
total of 74 eligible patients were finally enrolled. The proportion of patients with mRS score 0⁃2 at 90 days after stroke was 21.6%. The
rate of satisfied recanalization with mTICI2b⁃3 was 77%. The rate of all⁃cause mortality and intracranial hemorrhage during 90 days
after stroke was 36.4% and 35.1% ，respectively. A multivariable logistic regression analysis showed that non ⁃ paroxysmal atrial
fibrillation（OR=18.35，95%CI：1.98~169.77，P=0.010），baseline National Institute of Health stroke scale（NIHSS）score（OR=1.42，
95%CI：1.15~1.75，P < 0.001），total procedure time（OR=1.01，95%CI：1.00~1.02，P=0.030）were independent risk factors for poor
prognosis. Conclusions：MT treatment in elderly AF patients with AIS should be performed with caution，especially in those with high
NIHSS scoreand/or non⁃paroxysmal AF. In addition，efforts should be made to improve the anticoagulant rate of elderly patients with
AF to prevent stroke.
［Key words］ acute ischemic stroke；atrial fibrillation；elderly；mechanical thrombectomy
［J Nanjing Med Univ，2022，42（02）：194⁃199］
［基金项目］ 江苏省重点研发专项资金（BE2017750）
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通信作者（Corresponding author），E⁃mail：chenminglong@njmu.edu.cn