From the Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA (M.I., J.-M.O., M. Mlynash); Department of Neurology, Purpan University Hospital, Toulouse, France (J.-M.O., J.-F.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, APHP, Paris, France (E.M., P.A., M. Mazighi); INSERM U-1148, Laboratory of Vascular Translational Science and Paris-Diderot University, Paris, France (J.L., E.M., P.A., M. Mazighi); and Department of Biostatistics, EA2694, UDSL, Université Lille Nord de France, CHU Lille, France (J.L.).
Stroke. 2014 Jul;45(7):1992-8. doi: 10.1161/STROKEAHA.114.005084. Epub 2014 Jun 12.
In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization.
We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic stroke patients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days.
Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001).
DWI-ASPECTS≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved.
在接受静脉溶栓治疗的急性缺血性脑卒中患者中，弥散加权成像（DWI）阿尔伯塔卒中计划早期计算机断层扫描评分（ASPECTS）是功能结局的独立影响因素。我们的目的是评估治疗前 DWI-ASPECTS 对血管内治疗后结局的影响，重点是再通。
我们分析了 2007 年 4 月至 2013 年 3 月期间通过血管内途径治疗的急性缺血性脑卒中患者前瞻性临床登记处收集的数据。每个接受治疗前有明确颈内动脉或大脑中动脉闭塞的患者且接受急性 DWI-MRI 检查的患者均符合本研究条件。主要结局是 90 天时改良 Rankin 量表评分为 0 至 2 的良好结局。
共纳入 210 例患者，中位 DWI-ASPECTS 为 7（四分位间距，4-8）。DWI-ASPECTS≥5 是预测良好结局的最佳阈值（曲线下面积=0.69；敏感度，90%；特异性，38%）。在包括混杂变量的多变量分析中，与 DWI-ASPECTS≥5 相关的良好结局的调整优势比为 5.06（95%置信区间，1.86-13.77；P=0.002）。尽管如此，在 DWI-ASPECTS 低于 5 的患者中，完全再通与良好结局发生率增加相关（50%与 3%，P<0.001）。
在 6 小时内接受血管内再灌注治疗的患者中，DWI-ASPECTS≥5 似乎是预测良好结局的最佳阈值。当实现完全再通时，DWI-ASPECTS 小于 5 的选定患者仍可能受益。
