Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Department of Neurology, University Hospital Antwerp, Edegem, Belgium.
J Thromb Haemost. 2014 Jun;12(6):814-21. doi: 10.1111/jth.12561.
Recanalization in acute ischemic stroke with large-vessel occlusion is a potent indicator of good clinical outcome.
To identify easily available clinical and radiologic variables predicting recanalization at various occlusion sites.
All consecutive, acute stroke patients from the Acute STroke Registry and Analysis of Lausanne (2003-2011) who had a large-vessel occlusion on computed tomographic angiography (CTA) (< 12 h) were included. Recanalization status was assessed at 24 h (range: 12-48 h) with CTA, magnetic resonance angiography, or ultrasonography. Complete and partial recanalization (corresponding to the modified Treatment in Cerebral Ischemia scale 2-3) were grouped together. Patients were categorized according to occlusion site and treatment modality.
Among 439 patients, 51% (224) showed complete or partial recanalization. In multivariate analysis, recanalization of any occlusion site was most strongly associated with endovascular treatment, including bridging therapy (odds ratio [OR] 7.1, 95% confidence interval [CI] 2.2-23.2), and less so with intravenous thrombolysis (OR 1.6, 95% CI 1.0-2.6) and recanalization treatments performed beyond guidelines (OR 2.6, 95% CI 1.2-5.7). Clot location (large vs. intermediate) and tandem pathology (the combination of intracranial occlusion and symptomatic extracranial stenosis) were other variables discriminating between recanalizers and non-recanalizers. For patients with intracranial occlusions, the variables significantly associated with recanalization after 24 h were: baseline National Institutes of Health Stroke Scale (NIHSS) (OR 1.04, 95% CI 1.02-1.1), Alberta Stroke Program Early CT Score (ASPECTS) on initial computed tomography (OR 1.2, 95% CI 1.1-1.3), and an altered level of consciousness (OR 0.2, 95% CI 0.1-0.5).
Acute endovascular treatment is the single most important factor promoting recanalization in acute ischemic stroke. The presence of extracranial vessel stenosis or occlusion decreases recanalization rates. In patients with intracranial occlusions, higher NIHSS score and ASPECTS and normal vigilance facilitate recanalization. Clinical use of these predictors could influence recanalization strategies in individual patients.
急性缺血性脑卒中伴大血管闭塞患者的再通是临床转归良好的有力指标。
确定在不同闭塞部位预测再通的易于获得的临床和影像学变量。
将 2003 年至 2011 年期间急性脑卒中登记分析与洛桑研究（Acute STroke Registry and Analysis of Lausanne，ASL）中的所有连续急性脑卒中患者纳入研究，这些患者在计算机断层血管造影（computed tomographic angiography，CTA）上存在大血管闭塞（<12 h）。在 24 h 时通过 CTA、磁共振血管造影或超声检查评估再通情况（范围：12-48 h）。完全再通和部分再通（对应改良治疗脑缺血量表 2-3 级）被分为一组。根据闭塞部位和治疗方式对患者进行分类。
在 439 例患者中，51%（224 例）表现为完全或部分再通。多变量分析显示，任何部位的再通与血管内治疗最密切相关，包括桥接治疗（比值比 [odds ratio，OR]7.1，95%置信区间 [confidence interval，CI]2.2-23.2），与静脉溶栓（OR 1.6，95%CI 1.0-2.6）和超出指南的再通治疗（OR 2.6，95%CI 1.2-5.7）相关性稍差。栓子位置（大或中等）和串联病变（颅内闭塞与症状性颅外狭窄的联合）是区分再通和非再通患者的其他变量。对于颅内闭塞患者，24 h 后再通的显著相关因素包括：基线国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分（OR 1.04，95%CI 1.02-1.1）、初始计算机断层扫描的阿尔伯塔卒中项目早期 CT 评分（Alberta Stroke Program Early CT Score，ASPECTS）（OR 1.2，95%CI 1.1-1.3）和意识改变（OR 0.2，95%CI 0.1-0.5）。
急性血管内治疗是促进急性缺血性脑卒中再通的唯一最重要因素。颅外血管狭窄或闭塞的存在会降低再通率。对于颅内闭塞患者，较高的 NIHSS 评分、ASPECTS 和正常的警觉性有助于再通。这些预测因子的临床应用可能会影响个体患者的再通策略。
