Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg, Hamburg, Hamburg, Germany
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg, Hamburg, Hamburg, Germany.
J Neurointerv Surg. 2021 Jan;13(1):14-18. doi: 10.1136/neurintsurg-2020-015889. Epub 2020 May 15.
In patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.
Patients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as 'poor outcome'. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.
123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.
Poor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.
在接受机械取栓（MT）治疗的大血管闭塞（LVO）所致急性缺血性卒中患者中，MT 常可实现再通，但仅有约半数患者具有良好的临床转归。我们旨在确定与完全再通后临床结局不良相关的预测因素。
筛选了 2015 年 7 月至 2019 年 4 月期间接受前瞻性单中心卒中登记的 LVO 接受 MT 治疗的患者。完全再通定义为血栓溶解分级（TICI）3 级。90 天改良 Rankin 量表评分（mRS90）为 3-6 定义为“不良结局”。以不良结局为因变量，以基线临床数据、合并症、卒中严重程度、侧支循环状态和治疗信息为自变量进行 logistic 回归分析。
本研究纳入了 123 例完全再通（TICI 3 级）的患者，其中 67 例（54.5%）患者临床结局不良。多变量 logistic 回归分析确定年龄较大（校正比值比 1.10，95%置信区间 1.04 至 1.17；p=0.001）、入院时国立卫生研究院卒中量表评分较高（比值比 1.14，95%置信区间 1.02 至 1.28；p=0.024）和 Alberta 卒中项目早期 CT 评分较低（比值比 0.6，95%置信区间 0.4 至 0.84；p=0.007）是不良结局的独立预测因素。不良结局与侧支循环评分无关。
尽管实现了完全再通，但接受 MT 治疗的急性缺血性卒中患者中仍有很大比例临床结局不良。在本研究中，无效再通被证明与侧支循环状态无关，但与年龄增加和卒中严重程度相关。
