脑血管狭窄行支架植入术围术期缺血性卒中的危险因素

摘要

Objective To explore the predictors of perioperative ischemic stroke following percutaneous transluminal angioplasty and stenting.Methods We retrospectively evaluated data on 416 percutaneous transluminal angioplasty and stenting (PTAS) procedures at (334 males,82 females,aged 40-85 years,falling into ASA Ⅰ-Ⅲ) a single institution.Logistic regression was used to analyze the role of clinical,angiographic and hemodynamic variables on periprocedural ischemic strokes.Results Among 328 patients underwent PTAS for the treatment of extracranial stenosis,10 patients (3.0％) had perioperative ischemic stroke.Among the 88 stenting for intracranial stenosis,6 patients (6.8 ％) had perioperative ischemic stroke.Multivariable predictors of perioperative ischemic stroke for stenting for extracranial stenosis were the presence of untreated intracranial artery stenosis (OR =9.44,95％CI 2.36-37.71,P=0.001) and intraoperative absolute minimal SBP＜90 mm Hg (OR=9.13,95％CI 1.35-61.76,P =0.023).The independent predictors of perioperative ischemic stroke following PTAS for intracranial stenosis included the patients' increasing age (OR =1.25,95 ％ CI 1.04-1.51,P=0.021),presence of calcific plaques (OR=11.02,95％CI 1.11-109.25,P=0.040) and untreated intracranial artery stenosis (OR =44.81,95％ CI 1.99-1 011.84,P =0.017).Conclusion For patients with extracranial stenosis,suffering from the presence of untreated intracranial artery stenosis and intraoperative absolute minimal SBP＜90 mm Hg are the independent risk factors for perioperative ischemic stroke.The patients' increasing age,presence of calcific plaques and untreated intracranial artery stenosis were the independent risk factors for this complication in patients with intracranial stenosis.%目的 探讨经皮穿刺脑血管腔内球囊扩张/支架植入术(percutaneous transluminal angioplasty and stenting,PTAS)围术期缺血性卒中的危险因素.方法 选择医院颅内、外血管狭窄行PTAS的患者416例,男334例,女82例,年龄40～85岁,ASA Ⅰ～Ⅲ级.收集围术期缺血性卒中的发病率、人口学、既往史、神经系统及围术期血流动力学因素与临床结局的关系,回顾性探讨围术期缺血性卒中的危险因素.结果 颅外血管狭窄行PTAS的328例患者中,10例(3.0％)发生围术期缺血性卒中.颅内血管狭窄行PTAS的88例患者中,6例(6.8％)发生围术期缺血性卒中.颅外血管PTAS围术期脑卒中的危险因素包括术前合并未治疗的颅内血管狭窄(OR=9.44,95％CI2.36～37.71,P=0.001)和术中SBP最低值＜90 mm Hg(OR=9.13,95％CI 1.35～61.76,P=0.023).颅内血管PTAS围术期脑卒中的危险因素包括术前合并未治疗的颅内血管狭窄(OR=44.81,95％CI 1.99～1 011.84,P=0.017)、年龄增高(OR=1.25,95％CI 1.04～1.51,P=0.021)和存在钙化斑块(OR =11.02,95％CI 1.11～109.25,P=0.040).结论 在经皮穿刺脑血管腔内球囊扩张/支架植入术中,颅外血管PTAS围术期缺血性卒中的独立危险因素是术前合并未治疗的颅内血管狭窄和术中SBP最低值＜90 mm Hg,颅内血管PTAS围术期卒中的独立危险因素是年龄增高、存在钙化斑块以及术前合并未治疗的颅内血管狭窄.