Desilles Jean-Philippe, Consoli Arthuro, Redjem Hocine, Coskun Oguzhan, Ciccio Gabriele, Smajda Stanislas, Labreuche Julien, Preda Cristian, Ruiz Guerrero Clara, Decroix Jean-Pierre, Rodesch Georges, Mazighi Mikael, Blanc Raphaël, Piotin Michel, Lapergue Bertrand
From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France (J.-P. Desilles, H.R., G.C., S.S., C.R.G., M.M., R.B., M.P.); Department of Neurology, Division of Neurology, Stroke Center (J.-P. Decroix, B.L.) and Department of Interventional Neuroradiology (A.C., O.C., G.R.), Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P. Desilles, M.M., R.B., M.P., B.L.); Paris Diderot and Sorbonne Paris Cite Universities, France (M.M.); Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694-Santé publique: Epidémiologie et Qualité des Soins, F-59000 Lille, France (J.L., C.P.); and DHU NeuroVasc, Paris, France (M.M.).
Stroke. 2017 Apr;48(4):963-969. doi: 10.1161/STROKEAHA.116.015202. Epub 2017 Feb 24.
In acute ischemic stroke patients, diffusion-weighted imaging (DWI)-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is correlated with infarct volume and is an independent factor of functional outcome. Patients with pretreatment DWI-ASPECTS ≤6 were excluded or under-represented in the recent randomized mechanical thrombectomy trials. Our aim was to assess the impact of reperfusion in pretreatment DWI-ASPECTS ≤6 patients treated with mechanical thrombectomy.
We analyzed data collected between January 2012 and August 2015 in a bicentric prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with a documented internal carotid artery or middle cerebral artery occlusion with pretreatment DWI-ASPECTS ≤6 was eligible for this study. The primary end point was a favorable outcome defined by a modified Rankin Scale score ≤2 at 90 days.
Two hundred and eighteen patients with a DWI-ASPECTS ≤6 were included. Among them, 145 (66%) patients had successful reperfusion at the end of mechanical thrombectomy. Reperfused patients had an increased rate of favorable outcome (38.7% versus 17.4%; =0.002) and a decreased rate of mortality at 3 months (22.5% versus 39.1%; =0.013) compared with nonreperfused patients. The symptomatic intracranial hemorrhage rate was not different between the 2 groups (13.0% versus 14.1%; =0.83). However, in patients with DWI-ASPECTS <5, favorable outcome was low (13.0% versus 9.5%; =0.68) with a high mortality rate (45.7% versus 57.1%; =0.38) with or without successful reperfusion.
Successful reperfusion is associated with reduced mortality and disability in patients with a pretreatment DWI-ASPECTS ≤6. Further data from randomized studies are needed, particularly in patients with DWI-ASPECTS <5.
在急性缺血性卒中患者中，弥散加权成像（DWI）-阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）与梗死体积相关，并且是功能预后的独立因素。在近期的随机机械取栓试验中，预处理DWI-ASPECTS≤6的患者被排除或代表性不足。我们的目的是评估机械取栓治疗的预处理DWI-ASPECTS≤6患者再灌注的影响。
我们分析了2012年1月至2015年8月期间在一个双中心前瞻性临床登记处收集的数据，该登记处纳入了连续接受机械取栓治疗的急性缺血性卒中患者。每例记录有颈内动脉或大脑中动脉闭塞且预处理DWI-ASPECTS≤6的患者均符合本研究条件。主要终点是90天时改良Rankin量表评分≤2所定义的良好预后。
纳入了218例DWI-ASPECTS≤6的患者。其中，145例（66%）患者在机械取栓结束时成功再灌注。与未再灌注的患者相比，再灌注患者的良好预后率增加（38.7%对17.4%；P=0.002），3个月时死亡率降低（22.5%对39.1%；P=0.013）。两组间症状性颅内出血率无差异（13.0%对14.1%；P=0.83）。然而，在DWI-ASPECTS<5的患者中，无论是否成功再灌注，良好预后率都较低（13.0%对9.5%；P=0.68），死亡率较高（45.7%对57.1%；P=0.38）。
预处理DWI-ASPECTS≤6的患者成功再灌注与死亡率和残疾率降低相关。需要来自随机研究的进一步数据，尤其是在DWI-ASPECTS<5的患者中。
