Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Radiology Department, Hospital Clinic, Barcelona, Spain.
Sci Rep. 2017 Sep 14;7(1):11636. doi: 10.1038/s41598-017-11946-y.
A mTICI 2b or a mTICI 3 score are currently considered success following mechanical thrombectomy (MT) in acute stroke but is undetermined whether the two scores translate equivalent outcomes. We present a single-center, retrospective cohort of patients with anterior circulation stroke treated with MT and achieving a final mTICI score 2b or 3. A multimodal CT at baseline and a multimodal MRI at 24 hours assessed the growth of the infarct, and the modified Rankin Scale (mRS) assessed functional outcome at 90 days. The primary outcome was the shift analysis of the mRS at day 90 in ordinal regression adjusted for covariates (age, sex, pretreatment NIHSS score, target occlusion, infarct core, pretreatment alteplase), and the collateral score. Infarct growth was explored in a similarly adjusted multiple linear regression model. MT was started within a median of 285 minutes of symptom onset; 51 (41%) patients achieved a mTICI 2b, and 74 (59%), a mTICI 3. mTICI 3 resulted in better mRS score transitions than mTICI 2b (odds ratio 2.018 [95% CI 1.033-3.945], p = 0. 040), and reduced infarct growth (p = 0.002). We conclude that in patients with acute stroke receiving MT, success should be redefined as achieving a mTICI 3 score.
目前，在急性脑卒中患者接受机械取栓（MT）后，mTICI 2b 或 mTICI 3 评分被认为是成功的，但尚不确定这两个评分是否能转化为等效的结果。我们报告了一项单中心回顾性队列研究，该研究纳入了接受 MT 治疗且最终 mTICI 评分达到 2b 或 3 的前循环脑卒中患者。基线时进行多模态 CT，24 小时时进行多模态 MRI，以评估梗死的进展；改良 Rankin 量表（mRS）评估 90 天时的功能结局。主要结局是在调整协变量（年龄、性别、治疗前 NIHSS 评分、目标闭塞、梗死核心、治疗前阿替普酶）和侧支评分后，在序数回归中对第 90 天 mRS 的移位分析。梗死进展在同样调整的多元线性回归模型中进行了探索。MT 在症状发作后中位数 285 分钟内开始；51 名（41%）患者 mTICI 2b，74 名（59%）患者 mTICI 3。mTICI 3 导致 mRS 评分改善的可能性高于 mTICI 2b（比值比 2.018[95%CI 1.033-3.945]，p=0.040），并且梗死体积减少（p=0.002）。我们得出结论，在接受 MT 的急性脑卒中患者中，成功应重新定义为达到 mTICI 3 评分。
