急性大血管闭塞机械取栓术后再灌注损伤的危险因素OA

Objective To explore the risk factors for reperfusion injury after mechanical thrombectomy in patients with acute large vessel occlusion(ALVO),and to construct a risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 161 patients with ALVO who were admitted to our hospital from January 2022 to January 2025.These patients were divided into the occurrence group(n=61)and the non-occurrence group(n=100)based on whether postoperative reperfusion injury occurred.The clinical data of the patients between the two groups were compared,and LASSO and Logistic regression analyses were used to screen the risk factors for reperfusion injury after mechanical thrombectomy in ALVO patients.A nomogram prediction model was established and the model efficacy was verified.Results There were statistically significant differences in terms of the collateral circulation compensation status,high-density lipoprotein(HDL),low-density lipoprotein(LDL),triacylglycerol(TG),total cholesterol(TC),National Institutes of Health Stroke Scale(NIHSS)score,and Alberta Stroke Program Early CT Score(ASPECTS)between the two groups of patients(P<0.05).LASSO regression analysis showed no evidence of overfitting for the above indicators.Logistic regression analysis showed that poor collateral circulation compensation,high levels of LDL,TG,TC,and NIHSS score were all the risk factors for reperfusion injury after mechanical thrombectomy(OR>1,P<0.05),while a high ASPECTS score was a protective factor for reperfusion injury after mechanical thrombectomy(OR=0.518,P<0.05).Based on the results of Logistic regression analysis,a nomogram risk prediction model was constructed.The model was verified by Bootstrap method with 1000 resampling iterations,which yielded a Cox-Snell R2 of 0.72,and a Nagelkerke R2 of 0.529.The calibration curve showed that the model had good calibration;the clinical decision curve indicated that this prediction model had a high net benefit rate in clinical decision-making.Conclusion The poor collateral circulation compensation,high levels of LDL,TG and TC,and high NIHSS score before surgery are the independent risk factors for reperfusion injury after mechanical thrombectomy in ALVO patients,while the preoperative ASPECTS score is a protective factor.The risk prediction nomogram model constructed based on these factors has certain calibration and clinical practicability.