前循环串联病变患者急诊颈动脉支架置入后支架内再闭塞的影响因素及预后探讨 Exploration of the Influencing Factors and Prognosis of the In-Stent Reocclusion of Patients with Anterior Circulation Tandem Lesions after Carotid Artery Stenting during Emergency Treatment

Abstract

目的 探讨前循环串联病变患者颈动脉支架置入后支架内再闭塞的可能影响因素及预后情况。 方法 回顾性连续收集2020年6月—2022年9月于临沂市人民医院就诊的前循环串联病变且术中接受颈动脉支架置入治疗患者的临床资料，并分析上述患者手术操作过程、血管再通、术后并发症以及预后情况。同时依据90 d功能预后，将患者分为预后良好组与预后不良组，采用多元logistic回归分析影响患者预后的独立危险因素。 结果 本研究共纳入111例前循环串联病变且接受急诊颈动脉支架置入治疗的患者，术后有16例（14.4%）患者发生支架内再闭塞。分析发现支架内再闭塞患者术后残余狭窄程度较高且多数患者术前未进行充分的抗栓治疗。同时依据90 d功能预后，将111例患者分为预后良好组（66例）与预后不良组（45例），多元logistic回归分析显示术后支架内再闭塞（OR 0.315，95%CI 0.106～0.932，P=0.037）及术前梗死核心区体积（OR 0.978，95%CI 0.959～0.997，P=0.023）是影响患者预后的独立危险因素。 结论 前循环串联病变患者颈动脉支架置入后再闭塞可能与术后残余狭窄程度高、抗栓治疗不充分等因素相关,而术前梗死核心区体积以及支架内再闭塞是影响患者预后的独立危险因素。 Abstract: Objective To explore the possible influencing factors and prognosis of in-stent reocclusion of patients with anterior circulation tandem lesions after carotid artery stenting. Methods Retrospective continuous collection of the clinical data of patients with anterior circulation tandem lesions who underwent carotid artery stenting at Linyi People’s Hospital from June 2020 to September 2022, and analysis of surgical procedures, vascular recanalization, postoperative complications, and prognosis of these patients were performed in this study. Based on the 90-day functional outcome, patients were categorized into favorable and unfavorable prognosis groups, and multivariate logistic regression analysis was employed to identify independent risk factors influencing patient prognosis. Results This study included 111 patients with anterior circulation tandem lesions who received carotid artery stenting during emergency treatment. Postoperatively, 16 (14.4%) patients experienced in-stent reocclusion. Analysis displayed that patients with in-stent reocclusion had a higher degree of residual stenosis after surgery, and most patients did not receive sufficient antithrombotic therapy before surgery. Based on the 90-day functional prognosis, 111 patients were divided into a good prognosis group (66 cases) and a poor prognosis group (45 cases). Multivariate logistic regression analysis showed that postoperative in-stent reocclusion (OR 0.315, 95%CI 0.106-0.932, P=0.037) and preoperative infarct core volume (OR 0.978, 95%CI 0.959-0.997, P=0.023) were independent risk factors influencing the prognosis of patients. Conclusions Reocclusion after carotid artery stenting in patients with anterior circulation tandem lesions may be related to factors such as a high degree of postoperative residual stenosis and insufficient preoperative antithrombotic therapy. Preoperative infarct core volume and in-stent reocclusion are independent risk factors influencing the prognosis of patients.

Keywords

• 串联病变
• 颈动脉支架
• 再闭塞
• tandem lesion
• carotid stent
• reocclusion