Определение прогноза заболевания у пациентов с ишемическим инсультом после успешной тромбоэкстракции: клинические, нейрорадиологические и перипроцедурные предикторы

Эндоваскулярная тромбоэкстракция (ТЭ) – высокоэффективный метод восстановления кровотока у больных с окклюзией крупной церебральной артерии. Однако нередки ситуации, когда, несмотря на достигнутую реканализацию, неврологический дефицит остается на прежнем уровне или даже нарастает.

Цель исследования – определить факторы, связанные с хорошим и удовлетворительным функциональным восстановлением (mRS 0–3) после успешной ТЭ (достижение кровотока TICI 2b/3).

Материал и методы. В ретроспективный анализ было включено 90 пациентов c ишемическим инсультом в каротидной системе и выполненной ТЭ с достигнутым кровотоком TICI 2b/3. Была изучена прогностическая значимость клинических, нейрорадиологических и перипроцедурных факторов.

Результаты. По результатам однофакторного логистического регрессионного анализа выявлены предикторы хорошего или удовлетворительного исхода после ТЭ: степень неврологических нарушений (по шкале NIHSS) при поступлении (ОШ 0,87; 95% ДИ 0,79–1,02; p=0,005), NIHSS через 24 ч после ТЭ (ОШ 0,70; 95% ДИ 0,60–0,81; p<0,0005), наличие Т-окклюзии внутренней сонной артерии (ВСА) (ОШ 0,25; 95% ДИ 0,06–0,97; p=0,045), геморрагическая трансформация (ОШ 0,10; 95% ДИ 0,03–0,34; p<0,0005), объем с ранними КТ-признаками ишемии (ОШ 0,97; 95% ДИ 0,94–0,99; p<0,001), объем с rCBF <30% (ОШ 0,91; 95% ДИ 0,87–0,96; p<0,0005), объем зоны инфаркта к 3-м суткам (ОШ 0,95; 95% ДИ 0,92–0,97; p<0,0005), системная тромболитическая терапия (ОШ 5,79; 95% ДИ 1,24–26,96; p<0,0005), балл по шкале ASPECTS (ОШ 2,43; 95% ДИ 1,67–3,53; p<0,0005), балл по шкале еASPECTS (ОШ 1,53; 95% ДИ 1,18–2,0; p=0,002), T_max/rCBF несоответствие (ОШ 1,09; 95% ДИ 1,03–1,16; p=0,002). В ходе многофакторного логистического регрессионного анализа было отобрано три предиктора хорошего и удовлетворительного функционального восстановления после ТЭ: ASPECTS, число подходов ТЭ и геморрагическая трансформация (чувствительность модели – 95,7%, специфичность – 70,0%).

Заключение. Исход ишемического инсульта в случаях восстановления кровотока (реканализации) связан с совокупностью факторов, отражающих как исходное состояние вещества мозга, так и сложность хода операции, а также возникновение послеоперационных реперфузионных осложнений.

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