Zi Wenjie, Wang Huaiming, Yang Dong, Hao Yonggang, Zhang Meng, Geng Yu, Lin Min, Wan Yue, Shi Zhonghua, Zhou Zhiming, Wang Wei, Xu Haowen, Tian Xiguang, Lv Penghua, Wang Shuiping, Liu Wenhua, Wang Zhen, Liu Xintong, Guo Fuqiang, Zheng Dequan, Li Hua, Tu Mingyi, Jin Ping, Xiao Guodong, Liu Yuxiu, Xu Gelin, Xiong Yunyun, Liu Xinfeng
Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Cerebrovasc Dis. 2017;44(5-6):248-258. doi: 10.1159/000478667. Epub 2017 Aug 26.
This study was aimed at investigating the outcomes and predictors for the poor functional outcome after endovascular treatment (EVT) in a large, mostly Asian population.
Between January 2014 and June 2016, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enrolled from 21 stroke centers in China. The main outcomes were modified Rankin Scale (0-2 as functional independence, 3-6 as poor) at 90 days, symptomatic intracranial hemorrhage (sICH) at 72 h, and death at 90 days. Logistic regression was used to identify predictors for poor functional outcome at 90 days.
Of the 698 patients, 304 (43.6%) patients had functional independence at 90 days. The sICH rate was 15.5% (108/698) and mortality rate at 90 days was 25.4% (177/698). Age (OR 1.04, 95% CI 1.02-1.07), National Institutes of Health Stroke Scale score at admission (11-20 vs. ≤10, OR 2.38, 95% CI 1.23-4.59; ≥21 vs. ≤10, OR 3.66, 95% CI 1.72-7.80), baseline glucose level (OR 1.09, 95% CI 1.01-1.18), onset to groin puncture >6 h (OR 1.88, 95% CI 1.06-3.31), sICH (OR 15.49, 95% CI 5.16-46.43), and pneumonia (OR 3.15, 95% CI 1.86-5.32) were independent predictors of poor functional outcomes, while good recanalization (OR 0.26, 95% CI 0.13-0.54), preoperative Alberta Stroke Program Early CT Score 8-10 (OR 0.48, 95% CI 0.28-0.83), and good collateral flow (OR 0.50, 95% CI 0.32-0.79) were protective factors.
This study provides evidence in real world to support the performance of EVT in acute anterior circulation stroke patients in Chinese population. Patients with small infarct core, successful recanalization, good collateral status, and short treatment delay without sICH or pneumonia may benefit from EVT.
本研究旨在调查在一个以亚洲人群为主的大型队列中，血管内治疗（EVT）后功能预后不良的结局及预测因素。
回顾性纳入2014年1月至2016年6月期间来自中国21个卒中中心的急性前循环闭塞且接受EVT治疗的卒中患者。主要结局指标为90天时的改良Rankin量表评分（0 - 2分为功能独立，3 - 6分为功能预后不良）、72小时时的症状性颅内出血（sICH）以及90天时的死亡情况。采用逻辑回归分析确定90天时功能预后不良的预测因素。
698例患者中，304例（43.6%）在90天时功能独立。sICH发生率为15.5%（108/698），90天时的死亡率为25.4%（177/698）。年龄（比值比[OR]1.04，95%置信区间[CI]1.02 - 1.07）、入院时美国国立卫生研究院卒中量表评分（11 - 20分与≤10分相比，OR 2.38，95%CI 1.23 - 4.59；≥21分与≤10分相比，OR 3.66，95%CI 1.72 - 7.80）、基线血糖水平（OR 1.09，95%CI 1.01 - 1.18）、发病至股动脉穿刺时间>6小时（OR 1.88，95%CI 1.06 - 3.31）、sICH（OR 15.49，95%CI 5.16 - 46.43）以及肺炎（OR 3.15，95%CI 1.86 - 5.32）是功能预后不良的独立预测因素，而良好再通（OR 0.26，95%CI 0.13 - 0.54）、术前阿尔伯塔卒中项目早期CT评分8 - 10分（OR 0.48，95%CI 0.28 - 0.83）以及良好的侧支循环（OR 0.50，95%CI 0.32 - 0.79）是保护因素。
本研究提供了真实世界证据，支持在中国人群的急性前循环卒中患者中开展EVT治疗。梗死核心小、再通成功、侧支循环良好且治疗延迟短、无sICH或肺炎的患者可能从EVT治疗中获益。
