Parish Jonathan M, Rhoten Jeremy B, Strong Dale, Prasad Tanushree, Hines Andrew, Bernard Joe D, Clemente Jonathan, Karamchandani Rahul, Asimos Andrew W, Stetler William R
Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, USA.
Neurological Surgery, Carolinas Medical Center, Charlotte, USA.
Cureus. 2022 May 20;14(5):e25173. doi: 10.7759/cureus.25173. eCollection 2022 May.
Introduction Anterior temporal artery (ATA) visualization on computed tomography angiography (CTA) has been previously associated with good outcomes in middle cerebral artery (MCA) occlusions, but not in the setting of patients who initially present to non-thrombectomy centers. Methods We retrospectively identified acute MCA (M1) occlusion patients who underwent mechanical thrombectomy after transfer from non-thrombectomy-capable centers. Neuroradiologists confirmed the MCA (M1) as the most proximal site of occlusion on CTA and assessed for visualization of the ATA. Thrombolysis in Cerebral Infarction (TICI) 2b or greater revascularization scores were confirmed by neurointerventionalists blinded to patient outcomes. Ninety-day modified Rankin scale (mRS) scores were obtained via a structured telephone questionnaire. Results We identified 102 M1 occlusion patients over a three-and-a-half-year period presenting to a non-thrombectomy-capable center who underwent transfer and mechanical thrombectomy. There were no significant differences in age, gender, race, comorbidities, or median National Institute of Health Stroke Scale (NIHSS) scores between the ATA visualized (n = 47) versus non-visualized (n = 55) cohort, and no significant differences in baseline Alberta Stroke Program Early Computed Tomography (ASPECT) scores, post-intervention TICI scores, or interval from last known well to revascularization. There was a strong trend in functional independent outcome (mRS ≤ 2) for patients with ATA visualization (63.8% vs. 45.5%, p = 0.064). Conclusion For patients presenting to non-thrombectomy centers without CT perfusion capability, ATA visualization should be further investigated as an outcome predictor, given its association with functional independence after successful recanalization. This article was previously presented as a meeting abstract at the 2021 International Stroke Conference on March 17-19, 2021.
引言 既往研究表明，计算机断层血管造影（CTA）显示颞前动脉（ATA）与大脑中动脉（MCA）闭塞患者的良好预后相关，但在最初就诊于非血栓切除术中心的患者中并非如此。方法 我们回顾性纳入了从无血栓切除术能力的中心转诊后接受机械取栓的急性MCA（M1）闭塞患者。神经放射科医生在CTA上确认MCA（M1）为最近端闭塞部位，并评估ATA的显影情况。由对患者预后不知情的神经介入医生确认脑梗死溶栓（TICI）2b或更高的再灌注评分。通过结构化电话问卷获得90天改良Rankin量表（mRS）评分。结果 在三年半的时间里，我们纳入了102例就诊于无血栓切除术能力中心并接受转诊和机械取栓的M1闭塞患者。ATA显影组（n = 47）和未显影组（n = 55）在年龄、性别、种族、合并症或美国国立卫生研究院卒中量表（NIHSS）中位数评分方面无显著差异，在基线阿尔伯塔卒中项目早期计算机断层扫描（ASPECT）评分、干预后TICI评分或从最后一次已知健康状态到再灌注的时间间隔方面也无显著差异。ATA显影的患者在功能独立结局（mRS≤2）方面有强烈趋势（63.8%对45.5%，p = 0.064）。结论 对于就诊于无CT灌注能力的非血栓切除术中心的患者，鉴于ATA显影与成功再通后的功能独立性相关，应进一步研究其作为预后预测指标的价值。本文曾于2021年3月17 - 19日在2021年国际卒中会议上作为会议摘要发表。
