Colasurdo Marco, Chen Huanwen, Schrier Chad, Khalid Mazhar, Khunte Mihir, Miller Timothy R, Cherian Jacob, Malhotra Ajay, Gandhi Dheeraj
Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
J Neurointerv Surg. 2024 Feb 12;16(3):237-242. doi: 10.1136/jnis-2023-020220.
Large vessel recanalization (LVR) before endovascular therapy (EVT) for acute large vessel ischemic strokes is a poorly understood phenomenon. Better understanding of predictors for LVR is important for optimizing stroke triage and patient selection for bridging thrombolysis.
In this retrospective cohort study, consecutive patients presenting to a comprehensive stroke center for EVT treatment were identified from 2018 to 2022. Demographic information, clinical characteristics, intravenous thrombolysis (IVT) use, and LVR before EVT were recorded. Factors independently associated with different rates of LVR were identified, and a prediction model for LVR was constructed.
640 patients were identified. 57 (8.9%) patients had LVR before EVT. A minority (36.4%) of LVR patients had significant improvements in National Institutes of Health Stroke Scale. Independent predictors for LVR were identified and used to construct the 8-point HALT score: hyperlipidemia (1 point), atrial fibrillation (1 point), location of vascular occlusion (internal carotid: 0 points, M1: 1 point, M2: 2 points, vertebral/basilar: 3 points), and thrombolysis at least 1.5 hours before angiography (3 points). The HALT score had an area under the receiver-operating curve (AUC) of 0.85 (95% CI 0.81 to 0.90, P<0.001) for predicting LVR. LVR before EVT occurred in only 1 of 302 patients (0.3%) with low (0-2) HALT scores.
IVT at least 1.5 hours before angiography, site of vascular occlusion, atrial fibrillation, and hyperlipidemia are independent predictors for LVR. The 8-point HALT score proposed in this study may be a valuable tool for predicting LVR before EVT.
急性大血管缺血性卒中血管内治疗（EVT）前的大血管再通（LVR）是一种了解较少的现象。更好地了解LVR的预测因素对于优化卒中分诊和选择适合桥接溶栓治疗的患者非常重要。
在这项回顾性队列研究中，确定了2018年至2022年在一家综合卒中中心接受EVT治疗的连续患者。记录人口统计学信息、临床特征、静脉溶栓（IVT）使用情况以及EVT前的LVR情况。确定与不同LVR发生率独立相关的因素，并构建LVR预测模型。
共纳入640例患者。57例（8.9%）患者在EVT前出现LVR。少数（36.4%）LVR患者的美国国立卫生研究院卒中量表评分有显著改善。确定了LVR的独立预测因素并用于构建8分HALT评分：高脂血症（1分）、心房颤动（1分）、血管闭塞部位（颈内动脉：0分，M1：1分，M2：2分，椎基底动脉：3分）以及血管造影前至少1.5小时进行溶栓（3分）。HALT评分预测LVR的受试者操作特征曲线下面积（AUC）为0.85（95%CI 0.81至0.90，P<0.001）。HALT评分低（0-2分）的302例患者中只有1例（0.3%）在EVT前出现LVR。
血管造影前至少提前1.5小时进行IVT、血管闭塞部位、心房颤动和高脂血症是LVR的独立预测因素。本研究提出的8分HALT评分可能是预测EVT前LVR的有价值工具。
