Department of Neurology, CHRU Gui de Chauliac, Montpellier, France.
Department of Neuroradiology, Rambam Health Care Campus, Haifa, Israel.
J Neurointerv Surg. 2018 Jan;10(1):5-9. doi: 10.1136/neurintsurg-2017-013358. Epub 2017 Oct 27.
A low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke.
To evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct.
We retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis. A control group of 48 patients not eligible for reperfusion therapy gave us a perspective on the natural history. Clinical outcome was evaluated at 90 days using the modified Rankin Scale (mRS) score. Hemicraniectomy after malignant infarction, mortality, and symptomatic intracranial haemorrhage (sICH) were also reported.
Thrombolysis in Cerebral Infarction 2b-3 was assessed in 75% of treated patients. Reperfusion therapy led to significantly reduced disability (mRS score 0-2) at 90 days compared with the control group (30% vs 2.1%, p<0.001), hemicraniectomy (3.3% vs 22.9%, p=0.002), and death at 90 days (25% vs 47.9%, p=0.01). The sICH level was similar in treated patients and in the control group (p=0.78). Patients aged ≤70 years in the thrombectomy group had a significantly better clinical outcome than older patients (37.5% vs 10%, p=0.02), regardless of baseline characteristics or recanalization rate.
In patients with acute stroke in the anterior circulation and ASPECTS ≤5 revascularization therapy contributes to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.
基线 Alberta 卒中项目早期 CT 评分（ASPECTS）较低与急性卒中患者预后不良率低密切相关。
评估血管再通治疗在 ASPECTS≤5 的前循环梗死患者中的疗效和安全性。
我们回顾性分析了 108 例磁共振弥散加权成像（DWI）显示 ASPECTS 较低的连续患者。60 例患者接受了机械取栓治疗，其中 34 例同时接受了静脉溶栓治疗。48 例不符合再灌注治疗条件的患者作为对照组，为我们提供了自然史的视角。采用改良 Rankin 量表（mRS）评分评估 90 天的临床转归。还报告了恶性梗死后的去骨瓣减压术、死亡率和症状性颅内出血（sICH）。
75%的治疗患者达到了溶栓治疗 2b-3 标准。与对照组相比，再灌注治疗可显著降低 90 天的残疾程度（mRS 评分 0-2）（30% vs 2.1%，p<0.001）、去骨瓣减压术（3.3% vs 22.9%，p=0.002）和 90 天死亡率（25% vs 47.9%，p=0.01）。治疗组与对照组的 sICH 发生率相似（p=0.78）。在取栓组中，年龄≤70 岁的患者临床结局明显优于年龄较大的患者（37.5% vs 10%，p=0.02），无论基线特征或再通率如何。
在前循环急性卒中且 ASPECTS≤5 的患者中，血管再通治疗可在 90 天获得良好的临床转归，尤其是年龄小于 70 岁的患者。
