Department of Neurology, Emory University, Atlanta, Georgia, USA.
Department of Neurology, Neurosurgery and Radiology, Emory University, Atlanta, Georgia, USA.
J Neurointerv Surg. 2022 Feb;14(2):117-121. doi: 10.1136/neurintsurg-2020-017184. Epub 2021 Mar 15.
Patients with large vessel occlusion stroke (LVOS) and a low Alberta Stroke Program Early CT Score (ASPECTS) are often not offered endovascular therapy (ET) as they are thought to have a poor prognosis.
To compare the outcomes of patients with low and high ASPECTS undergoing ET based on baseline infarct volumes.
Review of a prospectively collected endovascular database at a tertiary care center between September 2010 and March 2020. All patients with anterior circulation LVOS and interpretable baseline CT perfusion (CTP) were included. Subjects were divided into groups with low ASPECTS (0-5) and high ASPECTS (6-10) and subsequently into limited and large CTP-core volumes (cerebral blood flow 30% >70 cc). The primary outcome measure was the difference in rates of 90-day good outcome as defined by a modified Rankin Scale (mRS) score of 0 to 2 across groups.
1248 patients fit the inclusion criteria. 125 patients had low ASPECTS, of whom 16 (12.8%) had a large core (LC), whereas 1123 patients presented with high ASPECTS, including 29 (2.6%) patients with a LC. In the category with a low ASPECTS, there was a trend towards lower rates of functional independence (90-day modified Rankin Scale (mRS) score 0-2) in the LC group (18.8% vs 38.9%, p=0.12), which became significant after adjusting for potential confounders in multivariable analysis (aOR=0.12, 95% CI 0.016 to 0.912, p=0.04). Likewise, LC was associated with significantly lower rates of functional independence (31% vs 51.9%, p=0.03; aOR=0.293, 95% CI 0.095 to 0.909, p=0.04) among patients with high ASPECTS.
Outcomes may vary significantly in the same ASPECTS category depending on infarct volume. Patients with ASPECTS ≤5 but baseline infarct volumes ≤70 cc may achieve independence in nearly 40% of the cases and thus should not be excluded from treatment.
由于认为预后较差， Alberta 卒中项目早期 CT 评分（ASPECTS）较低的大血管闭塞性卒中（LVOS）患者通常不接受血管内治疗（ET）。
根据基线梗死体积比较 ASPECTS 低和高的接受 ET 治疗的患者的结局。
回顾 2010 年 9 月至 2020 年 3 月在一家三级护理中心的前瞻性收集的血管内数据库。所有前循环 LVOS 且基线 CT 灌注（CTP）可解读的患者均被纳入研究。将患者分为 ASPECTS 低（0-5）和高（6-10）组，并进一步分为有限和大 CTP 核心体积（脑血流 30%＞70cc）组。主要结局测量指标为各组间 90 天改良 Rankin 量表（mRS）评分 0-2 的良好结局率差异。
1248 例患者符合纳入标准。125 例 ASPECTS 较低，其中 16 例（12.8%）有大核心（LC），1123 例 ASPECTS 较高，其中 29 例（2.6%）有 LC。在 ASPECTS 较低的组中，LC 组的功能独立性（90 天 mRS 评分 0-2）率呈下降趋势（18.8% vs 38.9%，p=0.12），但在多变量分析中调整潜在混杂因素后，差异有统计学意义（优势比[OR]为 0.12，95%置信区间[CI]为 0.016 至 0.912，p=0.04）。同样，在 ASPECTS 较高的患者中，LC 与功能独立性（31% vs 51.9%，p=0.03；OR 为 0.293，95%CI 为 0.095 至 0.909，p=0.04）显著降低相关。
根据梗死体积，同一 ASPECTS 类别中的结局可能有显著差异。ASPECTS≤5 但基线梗死体积≤70cc 的患者在近 40%的情况下可能实现独立，因此不应排除治疗。
