Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
J Neurointerv Surg. 2022 Sep;14(9):881-885. doi: 10.1136/neurintsurg-2021-017963. Epub 2021 Sep 20.
Despite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.
PubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.
Twelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD -0.71, 95% CI -1.23 to -0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.
This study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.
尽管血管内治疗后血管再通成功，但许多由于大血管闭塞导致的急性缺血性卒中患者仍存在功能依赖，即无效再通。
检索 PubMed 和 Embase 数据库，检索时间截至 2021 年 4 月 30 日。纳入报告血管内治疗急性缺血性卒中后无效再通危险因素的研究。采用荟萃分析合并各研究的均数差（MD）或比值比（OR）及其 95%置信区间（95%CI）。
共纳入 12 项研究，2138 例患者。汇总分析显示，年龄（MD 5.81，95%CI 4.16 至 7.46）、女性（OR 1.40，95%CI 1.16 至 1.68）、美国国立卫生研究院卒中量表（NIHSS）评分（MD 4.22，95%CI 3.38 至 5.07）、 Alberta 卒中项目早期 CT 评分（ASPECTS）（MD-0.71，95%CI-1.23 至-0.19）、高血压（OR 1.73，95%CI 1.43 至 2.09）、糖尿病（OR 1.78，95%CI 1.41 至 2.24）、心房颤动（OR 1.24，95%CI 1.01 至 1.51）、入院收缩压（MD 4.98，95%CI 1.87 至 8.09）、血清葡萄糖（MD 0.59，95%CI 0.37 至 0.81）、颈内动脉闭塞（OR 1.85，95%CI 1.17 至 2.95）、治疗前静脉溶栓（OR 0.67，95%CI 0.55 至 0.83）、发病至穿刺时间（MD 16.92，95%CI 6.52 至 27.31）、穿刺至再通时间（MD 12.37，95%CI 7.96 至 16.79）和治疗后症状性颅内出血（OR 6.09，95%CI 3.18 至 11.68）与无效再通显著相关。
本研究确定了女性、合并症、入院收缩压、血清葡萄糖、闭塞部位、非桥接治疗和术后并发症是无效再通的预测因素，也证实了先前报道的因素。需要进一步开展大规模前瞻性研究。
