Kim Young Dae, Nam Hyo Suk, Yoo Joonsang, Park Hyungjong, Sohn Sung-Il, Hong Jeong-Ho, Kim Byung Moon, Kim Dong Joon, Bang Oh Young, Seo Woo-Keun, Chung Jong-Won, Lee Kyung-Yul, Jung Yo Han, Lee Hye Sun, Ahn Seong Hwan, Shin Dong Hoon, Choi Hye-Yeon, Cho Han-Jin, Baek Jang-Hyun, Kim Gyu Sik, Seo Kwon-Duk, Kim Seo Hyun, Song Tae-Jin, Kim Jinkwon, Han Sang Won, Park Joong Hyun, Lee Sung Ik, Heo JoonNyung, Choi Jin Kyo, Heo Ji Hoe
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea.
J Stroke. 2021 May;23(2):244-252. doi: 10.5853/jos.2020.03622. Epub 2021 May 31.
We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.
Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.
Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).
The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
我们旨在开发一种模型，用于预测大血管闭塞患者静脉注射组织型纤溶酶原激活剂（t-PA）治疗后的早期再通情况。
利用来自两个不同多中心前瞻性队列的数据，我们确定了大血管闭塞性卒中患者在t-PA治疗后立即与早期再通相关的因素，并开发并验证了早期再通的预测模型。使用软件在薄层计算机断层扫描上半自动测量血栓体积，并使用Tan评分确定侧支循环程度。在t-PA治疗后立即进行随访血管造影研究以评估早期再通情况。
在推导队列中，t-PA推注后61.0±44.7分钟评估的早期再通率为15.5%（15/97），在验证队列中为10.5%（8/76）。血栓体积（优势比[OR]，0.979；95%置信区间[CI]，0.961至0.997；P=0.020）和良好的侧支循环（OR，6.129；95%CI，1.592至23.594；P=0.008）是与早期再通相关的显著因素。在推导队列和验证队列中，包含血栓体积的模型的曲线下面积（AUC）分别为0.819（95%CI，0.720至0.917）和0.842（95%CI，0.746至0.938）。当加入良好的侧支循环时，AUC有所改善（推导队列：AUC，0.876；95%CI，0.802至0.950；P=0.164；验证队列：AUC，0.949；95%CI，0.886至1.000；P=0.036）。综合判别改善也显示预测有显著改善（0.097；95%CI，0.009至0.185；P=0.032）。
使用血栓体积和侧支循环的模型预测了静脉注射t-PA后的早期再通情况，并且具有较高的性能。该模型可能有助于确定大血管闭塞性卒中患者的再通治疗策略。
