目的探讨对急性大动脉闭塞性脑梗死患者接受以机械取栓为主的动脉内多模式方法治疗的有效性和安全性及其影响预后的相关因素。方法回顾性分析56例急性大动脉闭塞性脑梗死患者的临床资料,观察临床特点(性别、年龄、相关基础疾病)、治疗时机(发病至穿刺时间、穿刺至开通时间)、多模式治疗(动脉内溶栓、取栓、球囊扩张、支架置入等)、责任血管分布等项目。评估血管再通情况采用改良脑梗死溶栓试验(m TICI)分级,观察术前和术后24 h神经功能采用美国国立卫生研究院卒中量表(NIHSS)评分,采用改良Rankin量表(mRS)评价术后3个月预后。根据术后3个月预后情况将入组患者分为预后良好组(34例,mRS≤2分)和预后不良组(22例,mRS≥3分),行单因素分析,再进一步行多因素Logistic回归分析影响预后的因素。结果 (1)56例患者血管再通率为78.6%(44例),其中基底动脉最高,达93.8%(15/16),大脑中动脉87.0%(20/23)。治疗后24 h NIHSS评分(10±7)分,低于入院时的(16±6)分,差异有统计学意义(t=6.401,P<0.01)。3个月预后良好34例(60.7%),死亡4例(7.1%),症状性颅内出血8例(14.3%)。(2)多因素分析显示:血管再通级别高,是良好预后的保护因素(OR=0.465,95%CI:0.267~0.809,P=0.007);糖尿病是预后不良的独立危险因素(OR=5.535,95%CI:1.101~27.835,P=0.038)。结论急性大动脉闭塞性脑梗死动脉内多模式治疗能快速有效地恢复颅内血流,具有开通率高和预后好的特点。并且血管再通级别越高,预后越好。而糖尿病是预后不良的独立危险因素。 Objective To investigate the efficacy and safety of multi-modal intra-arterial embolization in patients with acute aorta occlusive cerebral infarction and its related prognostic factors. Methods The clinical data of 56 patients with acute aortic occlusive cerebral infarction were retrospectively analyzed. The clinical features (gender, age, related underlying diseases), the timing of the treatment (onset to puncture time, puncture to open time), multimodal treatment Thrombolysis, thrombectomy, balloon dilatation, stent placement, etc.), responsible vascular distribution and other projects. The assessment of revascularization was performed by m TICI. Neurological function at preoperative and postoperative 24 h was assessed by NIH Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) Evaluation of 3 months after the prognosis. Patients were divided into good prognosis group (34 cases, mRS≤2 points) and poor prognosis group (22 cases, mRS≥3 points) according to the prognosis of 3 months after operation. Logistic regression analysis of prognostic factors. Results (1) The vascular recanalization rate in 56 patients was 78.6% (44 cases), of which the basilar artery was the highest (93.8%, 15/16) and the middle cerebral artery was 87.0% (20/23). NIHSS score (10 ± 7) at 24 h after treatment was lower than that at admission (16 ± 6), the difference was statistically significant (t = 6.401, P <0.01). Three months prognosis was good in 34 cases (60.7%), death in 4 cases (7.1%), and symptomatic intracranial hemorrhage in 8 cases (14.3%). (2) Multivariate analysis showed that the high grade of recanalization was the protective factor of good prognosis (OR = 0.465,95% CI: 0.267-0.809, P = 0.007); diabetes was the independent risk factor of poor prognosis (OR = 5.535 , 95% CI: 1.101 ~ 27.835, P = 0.038). Conclusion The multi-modal intra-arterial treatment of acute aortic occlusive cerebral infarction can rapidly and effectively recover the intracranial blood flow and has the characteristics of high opening rate and good prognosis. And the higher the recanalization level, the better the prognosis. Diabetes mellitus is an independent risk factor for poor prognosis.