Yang Hongchao, Lin Dinglai, Lin Xiaohui, Wu Yanmin, Yi Tingyu, Chen Wenhuo
Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
Front Neurol. 2022 Jun 1;13:856403. doi: 10.3389/fneur.2022.856403. eCollection 2022.
To explore the clinical prognosis and factors after mechanical thrombectomy (MT) in patients with large cerebral infarction assessed by computed tomographic perfusion (CTP)and the optimal threshold of cerebral blood flow (CBF) for estimating ischemic core.
We analyzed data from the anterior circulation database of our hospital (August 2018-June 2021). Multivariate logistic regression analyses identified the predictors of clinical outcomes for patients with large baseline infarcts (>50 ml) assessed by the MIStar software. The receiver operating characteristic (ROC) analysis was used to explore the cutoff value of factors.
The present study included one hundred thirty-seven patients with large baseline infarcts. Moreover, 23 (16.8%) patients achieved functionally independent outcomes, and 50 (36.5%) patients died at 90 days. A total of 20 (14.7%) patients had symptomatic intracranial hemorrhage (sICH). The multivariable analysis showed that higher age and larger core volume were independent of poor outcomes. The cutoff value of core volume was 90 ml, and the age was 76 years. Hypertension and rt-PA treatment were independent factors of sICH. Higher age and larger ischemic volume were independent risk factors of mortality.
Mechanical thrombectomy can be applied in patients with large ischemic core volumes. Patients older than 76 years with large cores (>90 ml) are unlikely to benefit from MT. These findings may be helpful in selecting patients with large baseline infarcts to be treated by MT. The threshold of CBF < 30% is the independent factor, and this is worth evaluating in future studies to find the optimal threshold of CBF.
探讨通过计算机断层扫描灌注（CTP）评估的大脑大面积梗死患者机械取栓（MT）后的临床预后及相关因素，以及用于估计缺血核心的脑血流量（CBF）的最佳阈值。
我们分析了我院前循环数据库（2018年8月至2021年6月）的数据。采用多因素逻辑回归分析确定通过MIStar软件评估的基线梗死面积较大（>50 ml）患者临床结局的预测因素。采用受试者工作特征（ROC）分析来探索各因素的临界值。
本研究纳入了137例基线梗死面积较大的患者。此外，23例（16.8%）患者获得了功能独立结局，50例（36.5%）患者在90天时死亡。共有20例（14.7%）患者发生了症状性颅内出血（sICH）。多变量分析显示，年龄较大和梗死核心体积较大与不良结局独立相关。梗死核心体积的临界值为90 ml，年龄为76岁。高血压和rt-PA治疗是sICH的独立因素。年龄较大和缺血体积较大是死亡的独立危险因素。
机械取栓可应用于缺血核心体积较大的患者。年龄大于76岁且梗死核心较大（>90 ml）的患者不太可能从MT中获益。这些发现可能有助于选择适合接受MT治疗的基线梗死面积较大的患者。CBF<30%的阈值是独立因素，这值得在未来研究中进行评估以找到CBF的最佳阈值。
