Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
World Neurosurg. 2019 May;125:e544-e551. doi: 10.1016/j.wneu.2019.01.131. Epub 2019 Feb 1.
To explore the differences among grades of recanalization on outcomes of endovascular treatment for acute anterior large vessel occlusion with small infarct core beyond the 6-hour time window.
Patients beyond the 6-hour time window with Alberta Stroke Program Early Computed Tomography Score >7 were retrospectively enrolled from the endovascular treatment for acute anterior circulation ischemic stroke (ACTUAL) registry. They were divided into 3 groups according to the degree of recanalization: modified treatment in cerebral infarction (mTICI) 0-2a, 2b, and 3. We compared the differences of outcomes among groups on modified Rankin Scale score at 90 days, symptomatic intracerebral hemorrhage within 72 hours, and mortality.
A total of 101 patients were enrolled. Median time from onset to groin puncture was 415 minutes (interquartile range: 387-497 minutes). Favorable functional outcomes were significantly better in patients with successful recanalization than in patients with failed recanalization (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 48.0% [12/25]; and mTICI 3, 61.1% [33/54]; trend P = 0.01). Complete recanalization (mTICI 3) (odds ratio, 5.34; 95% confidence interval, 1.71-16.66; P = 0.004) was associated with good functional outcome. Mortality was different among groups at 90 days (mTICI 0-2a, 36.4% [8/22]; mTICI 2b, 0, [0/25]; P = 0.001; mTICI 0-2a, 36.4% [8/22]; mTICI 3, 9.3% [5/54]; P = 0.008; and mTICI 2b, 0, [0/25]; mTICI 3, 9.3% [5/54]; P = 0.173). There were no significant differences of symptomatic intracranial hemorrhage among groups (mTICI 0-2a, 22.7% [5/22]; mTICI 2b, 12.0% [3/25]; and mTICI 3, 9.3% [5/54]; P = 0.28).
For acute anterior circulation stroke patients, who were beyond the 6-hour time window, yet with small ischemic core, complete recanalization following endovascular treatment may play the most important role on clinical outcome.
探讨急性前循环大血管闭塞患者在 6 小时时间窗以外，梗死核心体积小的患者血管再通程度与血管内治疗结局的关系。
回顾性分析血管内治疗急性前循环缺血性卒中（ACTUAL）登记研究中，6 小时时间窗以外，美国国立卫生研究院卒中量表早期 CT 评分＞7 的患者。根据再通程度分为 3 组：改良脑梗死溶栓（mTICI）分级 0-2a、2b 和 3 级。比较 90 天改良 Rankin 量表评分、72 小时内症状性颅内出血和死亡率在各组之间的差异。
共纳入 101 例患者。发病至股动脉穿刺中位时间为 415 分钟（四分位间距：387-497 分钟）。与再通失败患者相比，再通成功患者的功能结局更好（mTICI 0-2a：22.7%[5/22]；mTICI 2b：48.0%[12/25]；mTICI 3：61.1%[33/54]；趋势 P=0.01）。完全再通（mTICI 3）（优势比，5.34；95%置信区间，1.71-16.66；P=0.004）与良好的功能结局相关。90 天时各组死亡率不同（mTICI 0-2a：36.4%[8/22]；mTICI 2b：0[0/25]；P=0.001；mTICI 0-2a：36.4%[8/22]；mTICI 3：9.3%[5/54]；P=0.008；mTICI 2b：0[0/25]；mTICI 3：9.3%[5/54]；P=0.173）。各组症状性颅内出血无显著差异（mTICI 0-2a：22.7%[5/22]；mTICI 2b：12.0%[3/25]；mTICI 3：9.3%[5/54]；P=0.28）。
对于急性前循环卒中患者，在 6 小时时间窗以外且梗死核心体积小的患者，血管内治疗后的完全再通可能对临床结局起最重要的作用。
