Zhong Wansi, Chen Zhicai, Yan Shenqiang, Zhou Ying, Zhang Ruoxia, Luo Zhongyu, Yu Jun, Lou Min
Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
Brain Sci. 2022 Jun 24;12(7):821. doi: 10.3390/brainsci12070821.
Background: With the guidance of multi-mode imaging, the time window for endovascular thrombectomy (EVT) has been expanded to 24 h. However, poor clinical outcomes are still not uncommon. We aimed to develop a multi-mode imaging scale for endovascular therapy in patients with acute ischemic stroke (META) to predict the neurological outcome in patients receiving endovascular thrombectomy (EVT). Methods: We included consecutive acute ischemic stroke patients with occlusion of middle cerebral artery and/or internal carotid artery who underwent EVT. Poor outcome was defined as modified Rankin Scale (mRS) score of 3−6 at 3 months. A five-point META score was constructed based on clot burden score, multi-segment clot, the Alberta Stroke Program early computed tomography score of cerebral blood volume (CBV-ASPECTS), and collateral status. We evaluated the META score performance using area under the curve (AUC) calculations. Results: A total of 259 patients were included. A higher META score was independently correlated with poor outcomes at 3 months (odds ratio, 1.690, 95% CI, 1.340 to 2.132, p < 0.001) after adjusting for age, hypertension, baseline National Institutes of Health Stroke Scale (NIHSS) score, and baseline blood glucose. Patients with a META score ≥ 2 were less likely to benefit from EVT (mRS 3−6: 60.8% vs. 29.2%, p < 0.001). The META score predicted poor outcomes with an AUC of 0.714, higher than the Pittsburgh Response to Endovascular therapy (PRE) score, the totaled health risks in vascular events (THRIVE) score (AUC: 0.566, 0.706), and the single imaging marker in the scale. Conclusions: The novel META score could refine the predictive accuracy of prognosis after EVT, which might provide a promising avenue for future automatic imaging analysis to help decision making.
在多模式成像的指导下，血管内血栓切除术（EVT）的时间窗已扩大至24小时。然而，不良临床结局仍并不少见。我们旨在开发一种用于急性缺血性卒中患者血管内治疗的多模式成像量表（META），以预测接受血管内血栓切除术（EVT）患者的神经功能结局。方法：我们纳入了连续的接受EVT治疗的大脑中动脉和/或颈内动脉闭塞的急性缺血性卒中患者。不良结局定义为3个月时改良Rankin量表（mRS）评分为3 - 6分。基于血栓负荷评分、多节段血栓、阿尔伯塔卒中项目早期计算机断层扫描脑血容量评分（CBV-ASPECTS）和侧支循环状态构建了一个五分制的META评分。我们使用曲线下面积（AUC）计算来评估META评分的性能。结果：共纳入259例患者。在调整年龄、高血压、基线美国国立卫生研究院卒中量表（NIHSS）评分和基线血糖后，较高的META评分与3个月时的不良结局独立相关（比值比，1.690，95%置信区间，1.340至2.132，p < 0.001）。META评分≥2分的患者从EVT中获益的可能性较小（mRS 3 - 6分：60.8%对29.2%，p < 0.001）。META评分预测不良结局的AUC为0.714，高于匹兹堡血管内治疗反应（PRE）评分、血管事件总体健康风险（THRIVE）评分（AUC：0.566，0.706）以及该量表中的单一影像标志物。结论：新的META评分可提高EVT后预后的预测准确性，这可能为未来的自动影像分析以帮助决策提供一条有前景的途径。
