Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
Korean J Radiol. 2020 May;21(5):582-587. doi: 10.3348/kjr.2019.0578.
Endovascular thrombectomy (EVT) fails in approximately 20% of anterior circulation large vessel occlusion (AC-LVO). Nonetheless, the factors that affect clinical outcomes of non-recanalized AC-LVO despite EVT are less studied. The purpose of this study was to identify the factors affecting clinical outcomes in non-recanalized AC-LVO patients despite EVT.
This was a retrospective analysis of clinical and imaging data from 136 consecutive patients who demonstrated recanalization failure (modified thrombolysis in cerebral ischemia [mTICI], 0-2a) despite EVT for AC-LVO. Data were collected in prospectively maintained registries at 16 stroke centers. Collateral status was categorized into good or poor based on the CT angiogram, and the mTICI was categorized as 0-1 or 2a on the final angiogram. Patients with good (modified Rankin Scale [mRS], 0-2) and poor outcomes (mRS, 3-6) were compared in multivariate analysis to evaluate the factors associated with a good outcome.
Thirty-five patients (25.7%) had good outcomes. The good outcome group was younger (odds ratio [OR], 0.962; 95% confidence interval [CI], 0.932-0.992; = 0.015), had a lower incidence of hypertension (OR, 0.380; 95% CI, 0.173-0.839; = 0.017) and distal internal carotid artery involvement (OR, 0.149; 95% CI, 0.043-0.520; = 0.003), lower initial National Institute of Health Stroke Scale (NIHSS) (OR, 0.789; 95% CI, 0.713-0.873; < 0.001) and good collateral status (OR, 13.818; 95% CI, 3.971-48.090; < 0.001). In multivariate analysis, the initial NIHSS (OR, 0.760; 95% CI, 0.638-0.905; = 0.002), good collateral status (OR, 14.130; 95% CI, 2.264-88.212; = 0.005) and mTICI 2a recanalization (OR, 5.636; 95% CI, 1.216-26.119; = 0.027) remained as independent factors with good outcome in non-recanalized patients.
Baseline NIHSS score, good collateral status, and mTICI 2a recanalization remained independently associated with clinical outcome in non-recanalized patients. mTICI 2a recanalization would benefit patients with good collaterals in non-recanalized AC-LVO patients despite EVT.
血管内血栓切除术（EVT）在大约 20%的前循环大血管闭塞（AC-LVO）患者中失败。尽管如此，EVT 后非再通的 AC-LVO 患者影响临床结局的因素研究较少。本研究旨在确定影响 EVT 后非再通的 AC-LVO 患者临床结局的因素。
这是一项对 136 例连续接受 EVT 治疗但出现再通失败（改良脑梗死溶栓试验[mTICI]，0-2a）的 AC-LVO 患者的临床和影像学数据的回顾性分析。数据来自 16 个卒中中心前瞻性维护的登记处。根据 CT 血管造影将侧支循环状态分为良好或不良，根据最终血管造影将 mTICI 分为 0-1 或 2a。在多变量分析中比较良好结局（改良 Rankin 量表[mRS]，0-2）和不良结局（mRS，3-6）患者，以评估与良好结局相关的因素。
35 例患者（25.7%）有良好结局。良好结局组年龄较小（比值比[OR]，0.962；95%置信区间[CI]，0.932-0.992； = 0.015），高血压发生率较低（OR，0.380；95%CI，0.173-0.839； = 0.017），颈内动脉远端受累（OR，0.149；95%CI，0.043-0.520； = 0.003），初始国立卫生研究院卒中量表（NIHSS）评分较低（OR，0.789；95%CI，0.713-0.873； < 0.001），侧支循环良好（OR，13.818；95%CI，3.971-48.090； < 0.001）。多变量分析显示，初始 NIHSS 评分（OR，0.760；95%CI，0.638-0.905； = 0.002）、良好的侧支循环状态（OR，14.130；95%CI，2.264-88.212； = 0.005）和 mTICI 2a 再通（OR，5.636；95%CI，1.216-26.119； = 0.027）仍然是非再通患者良好结局的独立因素。
基线 NIHSS 评分、良好的侧支循环状态和 mTICI 2a 再通与 EVT 后非再通患者的临床结局仍存在独立相关性。mTICI 2a 再通有利于 EVT 后非再通的 AC-LVO 患者中具有良好侧支循环的患者。
