Department of Neurology Erasmus MC, University Medical Center Rotterdam the Netherlands.
Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam the Netherlands.
J Am Heart Assoc. 2021 Apr 6;10(7):e019988. doi: 10.1161/JAHA.120.019988. Epub 2021 Mar 19.
Background First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. Methods and Results FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01-1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06-1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03-1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01-1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (-37%; 95% CI, -43% to -31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83-2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24-hour NIHSS score, (-23%; 95% CI, -31% to -14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19-1.78)). Conclusions FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patient, imaging, and treatment characteristics. Factors associated with FPR were the experience of the interventionist, history of hyperlipidemia, location of occluded artery, and use of an aspiration device compared with stent thrombectomy.
背景 首次再通（FPR）与血管内治疗后的良好预后相关。尚不清楚这种效果是否独立于患者特征，以及在多次再通后，FPR 是否比优秀再通（扩展血栓切除术治疗脑梗死[eTICI]2C-3）有更好的结果。我们旨在评估 FPR 与结局之间的关联，并调整患者、影像学和治疗特征，以单独确定 FPR 的贡献。
方法 我们将 FPR 定义为 1 次通过后的 eTICI 2C-3。使用多变量回归模型来研究与 FPR 相关的特征，并研究 FPR 对结局的影响。我们纳入了 MR CLEAN（荷兰多中心急性缺血性卒中血管内治疗随机临床试验）登记处的 2686 例患者。与 FPR 相关的因素如下：高脂血症史（调整优势比[OR]，1.05；95%置信区间，1.01-1.10）、大脑中动脉与颅内颈内动脉闭塞（调整 OR，1.11；95%置信区间，1.06-1.16）以及抽吸与支架血栓切除术（调整 OR，1.07；95%置信区间，1.03-1.11）。介入医生的经验增加了 FPR 的可能性（调整 OR，每治疗 50 例患者增加 1.03；95%置信区间，1.01-1.06）。在调整了患者、影像学和治疗特征后，FPR 仍然与 24 小时 NIHSS 评分（-37%；95%置信区间，-43%至-31%）和 3 个月时改良 Rankin 量表（mRS）评分（调整后的常见 OR，2.16；95%置信区间，1.83-2.54）更好相关，而不是没有 FPR（多次再通+无优秀再通），与多次再通单独相比（24 小时 NIHSS 评分，-23%；95%置信区间，-31%至-14%），以及 mRS 评分（调整后的常见 OR，1.45；95%置信区间，1.19-1.78））。
结论 与多次再通相比，FPR 与患者、影像学和治疗特征独立相关，预后较好。与 FPR 相关的因素是介入医生的经验、高脂血症史、闭塞动脉的位置以及抽吸装置与支架血栓切除术的使用。
