Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
J Neurointerv Surg. 2022 Apr;14(4):333-340. doi: 10.1136/neurintsurg-2021-017507. Epub 2021 May 4.
First pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS.
We used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models.
Of 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (-45% (95% CI: -65% to -12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: -14% (95% CI: -51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)).
FPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.
在前循环闭塞动脉血管的血管内治疗（EVT）后，一次再通（即极好的再通（eTICI 2C-3）），即第一通再通（FPR），与良好的临床结果相关，甚至与多次极好的再通（MPR）相比也是如此。在后循环缺血性卒中（PCS）患者中，预计也会存在相同的关联，但目前尚不清楚。我们旨在评估与 FPR 相关的特征，以及 FPR 与 MPR 对 PCS 患者结局的影响。
我们使用了 MR CLEAN 登记研究的数据，这是一项前瞻性观察性研究。使用线性和有序逻辑回归模型检验 FPR 对 24 小时国立卫生研究院卒中量表（NIHSS）评分（以百分比降低表示）和 3 个月时改良 Rankin 量表（mRS）评分的影响。
在 224 名 PCS 患者中，45 名患者有 FPR，47 名患者有 MPR，90 名患者没有极好的再通（eTICI <2C）。我们没有发现任何患者、影像学或治疗特征与 FPR 之间存在关联。与没有 FPR 相比，FPR 与更好的 NIHSS 评分（-45%（95%CI：-65%至-12%））和更好的 mRS 评分（校正后的常见比值比（acOR）：2.16（95%CI：1.23 至 3.79））相关。与 MPR 相比，FPR 后的结局也更为有利，但效果较小，且无统计学意义（NIHSS：-14%（95%CI：-51%至 49%），mRS acOR：1.50（95%CI：0.75 至 3.00））。
与没有 FPR 相比，PCS 患者的 FPR 与良好的临床结局相关。与 MPR 相比，FPR 的效果不再具有统计学意义。尽管如此，我们的数据支持这样一种观点，即 FPR 应该成为每个接受 EVT 治疗的患者追求的治疗目标。
