Ni Heng, Wang Bin, Hang Yu, Liu Sheng, Jia Zhen-Yu, Shi Hai-Bin, Zhao Lin-Bo
Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
World Neurosurg. 2023 Mar;171:e752-e759. doi: 10.1016/j.wneu.2022.12.101. Epub 2022 Dec 27.
The predictors of futile recanalization in patients with intracranial atherosclerosis (ICAS)-related stroke are not understood. This study aimed to identify the predictors of futile recanalization after endovascular treatment (EVT) in patients who experience an acute stroke caused by ICAS-related occlusion.
We retrospectively reviewed the data of patients with ICAS-related stroke who underwent EVT from January 2018 to July 2021. Futile recanalization was defined as functional dependence (modified Rankin scale 3-6) despite successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2 b/3). Multivariate logistic regression analysis was used to determine the risk factors associated with futile recanalization. The receiver operating characteristic curve was used to examine the predictive value of the risk prediction model for futile recanalization.
Of the 87 patients enrolled, futile recanalization was observed in 32 (36.8%). Multivariate logistic analysis showed that older age (OR, 1.05; 95% CI, 1.01-1.10; P = 0.026), a higher National Institutes of Health Stroke Scale (NIHSS) score on admission (OR, 1.25; 95% CI, 1.08-1.45; P = 0.003), and poor collaterals (OR, 5.49; 95% CI, 1.70-17.79; P = 0.004) were independently associated with futile recanalization after EVT in patients with ICAS-related stroke. The receiver operating characteristic curve showed that the model in combination with age, admission NIHSS score, and collateral status could accurately predict futile recanalization in these patients (areas under the curve, 0.85; 95% CI, 0.76-0.92; P < 0.001).
Older age, higher NIHSS score on admission, and poor collaterals are predictors of futile recanalization in patients with ICAS-related stroke.
颅内动脉粥样硬化（ICAS）相关卒中患者无效再通的预测因素尚不明确。本研究旨在确定ICAS相关闭塞所致急性卒中患者接受血管内治疗（EVT）后无效再通的预测因素。
我们回顾性分析了2018年1月至2021年7月接受EVT的ICAS相关卒中患者的数据。无效再通定义为尽管成功再灌注（改良脑梗死溶栓评分2b/3）但仍存在功能依赖（改良Rankin量表评分3 - 6分）。采用多因素逻辑回归分析确定与无效再通相关的危险因素。采用受试者工作特征曲线检验无效再通风险预测模型的预测价值。
在纳入的87例患者中，32例（36.8%）观察到无效再通。多因素逻辑分析显示，年龄较大（比值比[OR]，1.05；95%置信区间[CI]，1.01 - 1.10；P = 0.026）、入院时美国国立卫生研究院卒中量表（NIHSS）评分较高（OR，1.25；95% CI，1.08 - 1.45；P = 0.003）以及侧支循环不良（OR，5.49；95% CI，1.70 - 17.79；P = 0.004）与ICAS相关卒中患者EVT后无效再通独立相关。受试者工作特征曲线显示，结合年龄、入院NIHSS评分和侧支循环状态的模型能够准确预测这些患者的无效再通（曲线下面积，0.85；95% CI，0.76 - 0.92；P < 0.001）。
年龄较大、入院时NIHSS评分较高以及侧支循环不良是ICAS相关卒中患者无效再通的预测因素。
