急性缺血性脑卒中机械取栓后出血转化的分型及影响因素

Classification and influencing factors of hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke

关键词:  急性缺血性脑卒中  机械取栓  出血转化  影响因素

Key words:  acute ischemic stroke  mechanical thrombectomy  hemorrhagic transformation  influencing factors

摘要:

摘　要：目的　 探讨急性缺血性脑卒中（AIS）机械取栓后出血转化（HT）的分型及影响因素。方法　回顾性分析 436 例AIS机械取栓患者的临床资料，总结HT发生、临床分型和影像学分型，多因素logistic回归分析AIS机械取栓后 HT的影响因素。结果 HT发生率为 16.5%，无症状、轻度症状、重度症状HT分别占HT总数的 41.7%、31.9%和 26.4%。 HI-1、HI-2、PH-1、PH-2 型分别占HT总数的 43.1%、25.0%、20.8%和 11.1%。糖尿病、取栓次数≥3 次、入院时NIHSS评 分＞15 分、术前CTA侧支循环评分≤3 级、心源性栓塞型AIS、发病至入院时间＞6 h是HT的独立危险因素（P<0.01 或 0.05）。结论 AIS机械取栓后以无症状HT和HI-1 型较为常见；AIS机械取栓后HT的独立危险因素较多。

Abstract:

Abstract: Objective To investigate the classification and influencing factors of hemorrhagic transformation (HT) after mechanical thrombectomy in acute ischemic stroke (AIS). Methods Clinical data of 436 patients after mechanical thrombectomy in AIS were retrospective collected, and occurrence, clinical classification and imaging classification of HT were summarized. The influencing factors were analyzed by multivariate logistic regression. Results The incidence of HT was 16.5%, of which asymptomatic, mild and severe HT accounted for 41.7%, 31.9% and 26.4%, and HI-1, HI-2, PH-1 and PH-2 types for 43.1%, 25.0%, 20.8% and 11.1%, respectively. Diabetes, number of thrombectomy ≥3 times, NIHSS score >15 at admission, preoperative CTA collateral circulation score ≤3 grade, cardioembolic AIS, and interval from onset to admission >6 hours are independent risk factors for HT (P<0.01 or 0.05). Conclusion Asymptomatic HT and HI-1 type are the most common HT following mechanical thrombectomy of AIS, with multiple independent risk factors.