Barreto Andrew D, Albright Karen C, Hallevi Hen, Grotta James C, Noser Elizabeth A, Khaja Aslam M, Shaltoni Hashem M, Gonzales Nicole R, Illoh Kachi, Martin-Schild Sheryl, Campbell Morgan S, Weir Raymond U, Savitz Sean I
Department of Neurology, Stroke Division, University of Texas, Houston Health Science Center, Houston, TX 77030, USA.
Stroke. 2008 Dec;39(12):3231-5. doi: 10.1161/STROKEAHA.108.521054. Epub 2008 Sep 4.
Studies have established a relation between recanalization and improved clinical outcome in acute ischemic stroke patients; however, intra-arterial clot size has not been routinely assessed. The aim of the study was to determine the impact of intra-arterial thrombus burden on intra-arterial treatment (IAT) and clinical outcome.
A retrospective review of our IAT stroke database included procedure time, recanalization, symptomatic intracranial hemorrhage, poor outcome (modified Rankin Scale score >/=4 at discharge), and mortality. The modified Thrombolysis in Myocardial Infarction thrombus grade was dichotomized into grades 0 to 3 (no clot or moderate thrombus, <2 vessel diameters) versus grade 4 (large thrombus, >2 vessel diameters).
Data were collected on 135 patients with thrombus grading. The baseline median National Institutes of Health Stroke Scale score was higher in patients of grade 4 compared with grades 0 to 3 (19 vs 17, P=0.012). Grade 4 thrombi required longer (median, range) times for IAT (113, 37 to 415 minutes vs 74, 22 to 215 minutes, respectively; P<0.001) and higher rates of mechanical clot disruption (wire, angioplasty, snare, stent, or Merci retriever) compared with grades 0 to 3 (76% vs 53%, P=0.005). There were no differences in rates of symptomatic intracranial hemorrhage (6.6% vs 4.1%, P=0.701) or recanalization (50% vs 61%, P=0.216) in grade 4 versus grades 0 to 3. Multivariate analysis adjusted for age, baseline National Institutes of Health Stroke Scale score, and artery of involvement showed that grade 4 thrombi were independently associated with poor outcome (odds ratio=2.4; 95% CI, 1.06 to 5.57; P=0.036) and mortality (odds ratio=4.0; 95% CI, 1.2 to 13.2; P=0.023).
High thrombus grade as measured by the modified Thrombolysis in Myocardial Infarction criteria may be a risk factor that contributes to poor clinical outcome.
研究已证实急性缺血性卒中患者的血管再通与临床预后改善之间存在关联；然而，动脉内血栓大小尚未常规评估。本研究的目的是确定动脉内血栓负荷对动脉内治疗（IAT）及临床预后的影响。
对我们的IAT卒中数据库进行回顾性分析，纳入手术时间、血管再通情况、症状性颅内出血、不良预后（出院时改良Rankin量表评分≥4分）及死亡率。改良的心肌梗死溶栓血栓分级被分为0至3级（无血栓或中度血栓，<2个血管直径）与4级（大血栓，>2个血管直径）。
收集了135例有血栓分级患者的数据。4级患者的基线美国国立卫生研究院卒中量表评分中位数高于0至3级患者（19分对17分，P = 0.012）。与0至3级相比，4级血栓的IAT所需时间更长（中位数，范围）（分别为113分钟，37至415分钟对74分钟，22至215分钟；P < 0.001），且机械性血栓破碎（使用导丝、血管成形术、圈套器、支架或Merci取栓器）的发生率更高（7６%对5３%，P = 0.005）。4级与0至3级在症状性颅内出血发生率（6.6%对4.1%，P = 0.701）或血管再通率（50%对61%，P = 0.216）方面无差异。对年龄、基线美国国立卫生研究院卒中量表评分及受累动脉进行多因素分析调整后显示，4级血栓与不良预后（比值比 = 2.4；95%可信区间，1.06至5.57；P = 0.036）及死亡率（比值比 = 4.0；95%可信区间，1.2至13.2；P = 0.023）独立相关。
根据改良的心肌梗死溶栓标准测量的高血栓分级可能是导致不良临床预后的一个危险因素。
