Department of Neurosurgery, Medical University of South Carolina, Charleston.
Department of Neurology, Medical University of South Carolina, Charleston.
JAMA Netw Open. 2021 Dec 1;4(12):e2137708. doi: 10.1001/jamanetworkopen.2021.37708.
Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct.
To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score.
All patients underwent MT in one of the included centers.
A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset).
A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful recanalization; P = .007). Having a low ASPECTS (odds ratio, 0.60; 95% CI, 0.38-0.85; P = .002) and presenting in the extended window (odds ratio, 0.69; 95% CI, 0.55-0.88; P = .001) were associated with worse 90-day outcome after controlling for potential confounders, without significant interaction between these 2 factors (P = .64).
In this cohort study, more than 1 in 5 patients presenting with an ASPECTS of 2 to 5 achieved 90-day functional independence after MT. A favorable outcome was nearly 5 times more likely for patients with low ASPECTS who had successful recanalization. The association of a low ASPECTS with 90-day outcomes did not differ for patients presenting in the early vs extended MT window.
关于在出现大核心梗死的现实世界患者中进行机械取栓术 (MT) 的结果，数据有限。
研究 MT 治疗大血管闭塞和 Alberta 卒中计划早期计算机断层扫描评分 (ASPECTS) 为 2 至 5 的患者的安全性和有效性。
设计、地点和参与者：这项回顾性队列研究使用了来自 Stroke Thrombectomy 和动脉瘤登记处 (STAR) 的数据，该登记处结合了美国、欧洲和亚洲的 28 个血栓切除术能力的卒中中心的前瞻性维护数据库。该研究纳入了 2016 年 1 月 1 日至 2020 年 12 月 31 日期间因颈内动脉或大脑中动脉 M1 段闭塞而就诊的 2345 例患者。患者在干预后 90 天内接受随访。ASPECTS 是一种基于基线非对比计算机断层扫描上早期缺血性改变程度的 10 分评分系统，得分为 10 表示正常，得分为 0 表示评分中包含的所有区域均存在缺血性改变。
所有患者均在其中一个纳入中心接受 MT。
使用多变量回归模型评估与 90 天良好结局（改良 Rankin 量表评分为 0-2）相关的因素，包括 ASPECTS 为 2 至 5 与在扩展时间窗（症状出现后 6-24 小时）内接受 MT 之间的交互项。
共纳入 2345 例接受 MT 的患者（1175 例女性 [50.1%]；中位年龄为 72 岁 [IQR，60-80 岁]；2132 例患者 [90.9%] 的 ASPECTS 为≥6，213 例患者 [9.1%] 的 ASPECTS 为 2-5）。在 90 天时，213 例 ASPECTS 为 2 至 5 的患者中有 47 例（22.1%）改良 Rankin 量表评分为 0 至 2（25.6% [176 例中的 45 例]成功再通的患者 [改良脑缺血溶栓评分≥2B]与 5.4% [37 例中的 2 例]未成功再通的患者；P = .007）。低 ASPECTS（比值比，0.60；95%CI，0.38-0.85；P = .002）和在扩展时间窗内就诊（比值比，0.69；95%CI，0.55-0.88；P = .001）与在控制潜在混杂因素后 90 天结局较差相关，这两个因素之间没有显著的相互作用（P = .64）。
在这项队列研究中，超过 1/5 的 ASPECTS 为 2 至 5 的患者在接受 MT 后 90 天达到功能独立。低 ASPECTS 且再通成功的患者更有可能获得 90 天的良好结局。低 ASPECTS 与 90 天结局的相关性在早期和扩展 MT 时间窗内的患者中没有差异。
