Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Road, Yuzhong District, Chongqing 400010, China.
Department of Neurology, Army Medical Center of PLA, No.10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106684. doi: 10.1016/j.jstrokecerebrovasdis.2022.106684. Epub 2022 Aug 22.
The purpose of this study was to evaluate the impact of reperfusion in patients with large vessel occlusion (LVO) of the anterior circulation and National Institutes of Health Stroke Scale (NIHSS)< 6.
It was a retrospective cohort study. The reperfusion grade was determined using the modified thrombolysis in cerebral infarction (TICI) score. The modified Rankin Score (mRS) ≤1 were defined as excellent and (mRS) ≤2 as favorable outcome at 3-month. Meanwhile, the all-cause mortality, intracerebral hemorrhage, and complications were recorded. Multivariate logistic regression analyses were performed to evaluate outcomes.
Seventy-six patients (86.4%) achieved reperfusion (TICI2B/3). Excellent outcome was achieved in 62 (70.5%) and favorable outcome in 69 (78.4%). All-cause death occurred in 2 (2.3%). The rate of excellent outcome in patients with TICI0,1,2A was 41.7%, with TICI2B 69.2%, and with TICI3 78.0% (p < 0.05). In a multivariate logistic regression analysis related to excellent outcome, the OR(95% CI) was 5.68(1.35,23.95) for TICI3; the test for linear trend by entering categorical variables as continuous variables in the adjusted model (p for trend=0.02<0.05), defining TICI0,1,2A as reference. Subgroup analyses showed without intravenous thrombolysis (IVT) (OR, 14.29; 95% CI, 1.76-116.37) and with middle cerebral artery (MCA) occlusion (OR, 7.97; 95% CI,1.26-50.32), the excellent outcome further improved with TICI3. Findings were similar in favorable outcome.
Our results indicated that successful reperfusion was intensely connected with better functional outcomes for patients with LVO presenting with NIHSS<6 in the anterior circulation, especially MCA occlusion and pretreatment without IVT.
本研究旨在评估前循环大血管闭塞（LVO）且美国国立卫生研究院卒中量表（NIHSS）评分＜6 的患者再灌注的影响。
这是一项回顾性队列研究。使用改良脑梗死溶栓（TICI）评分来确定再灌注等级。改良Rankin 量表（mRS）评分≤1 定义为 3 个月时的优效结局，mRS 评分≤2 定义为良效结局。同时记录全因死亡率、颅内出血和并发症。采用多变量逻辑回归分析评估结局。
76 例患者（86.4%）实现再灌注（TICI2B/3）。62 例（70.5%）患者获得优效结局，69 例（78.4%）患者获得良效结局。全因死亡 2 例（2.3%）。TICI0、1、2A 的优效结局发生率为 41.7%，TICI2B 为 69.2%，TICI3 为 78.0%（p＜0.05）。在与优效结局相关的多变量逻辑回归分析中，TICI3 的 OR（95%CI）为 5.68（1.35，23.95）；在调整模型中，将分类变量作为连续变量输入的线性趋势检验（p 趋势=0.02＜0.05），将 TICI0、1、2A 定义为参照。亚组分析显示，无静脉溶栓（IVT）（OR，14.29；95% CI，1.76-116.37）和大脑中动脉（MCA）闭塞（OR，7.97；95% CI，1.26-50.32）时，TICI3 可进一步改善优效结局。在良效结局方面，结果类似。
本研究结果表明，前循环 LVO 且 NIHSS＜6 的患者，再灌注成功与更好的功能结局密切相关，尤其是 MCA 闭塞和治疗前无 IVT 的患者。
