全脑小血管病负担预测急性缺血性脑卒中患者血管内治疗后的结局。

Total Cerebral Small Vessel Disease Burden Predicts the Outcome of Acute Stroke Patients after Intra-Arterial Thrombectomy.

机构信息

Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.

Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer, Guangzhou, China.

出版信息

Cerebrovasc Dis. 2023;52(6):616-623. doi: 10.1159/000528603. Epub 2023 Mar 13.

DOI:10.1159/000528603

PMID:36913934

Abstract

INTRODUCTION

Various types of cerebral small vessel diseases (cSVD) markers commonly coexist. The neurological function outcome is affected by their combined effect. To investigate the effect of cSVD on intra-arterial thrombectomy (IAT), our study aimed at developing and testing a model with fusing a combination of multiple cSVD markers as total cSVD burden to predict the outcome of acute ischemic stroke (AIS) patients after IAT treatment.

METHODS

From October 2018 to March 2021, continuous AIS patients with IAT treatment were enrolled. We calculated the cSVD markers identified by magnetic resonance imaging. The outcomes of all patients were assessed according to the modified Rankin Scale (mRS) score at 90 days after stroke. The relationship between total cSVD burden and outcomes was analyzed by logistics regression analysis.

RESULTS

A total of 271 AIS patients were included in this study. The proportions of score 0∼4 in the total cSVD burden group (i.e., score 0, 1, 2, 3, and 4 groups) were 9.6%, 19.9%, 23.6%, 32.8%, and 14.0%, respectively. The higher the cSVD score, the more patients with a poor outcome. Heavier total cSVD burden (1.6 [1.01∼2.27]), diabetes mellitus (1.27 [0.28∼2.23]), and higher national institute of health stroke scale (NIHSS) on admission (0.15 [0.07∼0.23]) were associated with poor outcome. In the two Least Absolute Shrinkage and Selection Operator regression models, model 1 using age, duration from onset to reperfusion, Alberta stroke program early CT score (ASPECTS), NIHSS on admission, modified thrombolysis in cerebral infarction (mTICI) and total cSVD burden as variables perform well on predicting short-term outcome in area under curve (AUC) of 0.90. Model 2, including all of the variables above except cSVD, showed less predictive capability than model 1 (AUC 0.90 vs. 0.82, p = 0.045).

CONCLUSIONS

The total cSVD burden score was independently associated with the clinical outcomes of AIS patients after IAT treatment and it may be a reliable predictor for poor outcomes of AIS patients after IAT treatment.

摘要

简介

各种类型的脑小血管疾病（cSVD）标志物通常同时存在。神经功能预后受其共同作用的影响。为了研究 cSVD 对动脉内血栓切除术（IAT）的影响，我们的研究旨在开发和测试一种模型，该模型将多种 cSVD 标志物的组合作为总 cSVD 负担融合在一起，以预测 IAT 治疗后急性缺血性脑卒中（AIS）患者的结局。

方法

本研究连续纳入 2018 年 10 月至 2021 年 3 月接受 IAT 治疗的急性脑梗死患者。我们计算了磁共振成像确定的 cSVD 标志物。所有患者的结局均根据卒中后 90 天的改良 Rankin 量表（mRS）评分进行评估。采用逻辑回归分析总 cSVD 负担与结局的关系。

结果

本研究共纳入 271 例 AIS 患者。总 cSVD 负担组（即评分 0、1、2、3 和 4 组）中评分 0∼4 的比例分别为 9.6%、19.9%、23.6%、32.8%和 14.0%。cSVD 评分越高，预后不良的患者越多。较重的总 cSVD 负担（1.6[1.01∼2.27]）、糖尿病（1.27[0.28∼2.23]）和较高的国立卫生研究院卒中量表（NIHSS）入院评分（0.15[0.07∼0.23]）与不良结局相关。在两个最小绝对收缩和选择算子回归模型中，模型 1 采用年龄、发病至再灌注时间、阿尔伯塔卒中项目早期 CT 评分（ASPECTS）、入院 NIHSS、改良脑梗死溶栓（mTICI）和总 cSVD 负担作为变量，在曲线下面积（AUC）为 0.90 时对短期结局的预测效果良好。模型 2 包括上述所有变量，但不包括 cSVD，其预测能力低于模型 1（AUC 0.90 与 0.82，p=0.045）。