Li Yi, Cao Wenbo, Xu Xin, Li Tianhua, Chen Yanfei, Wang Yabing, Chen Jian, Gao Peng, Yang Bin, Dmytriw Adam A, Regenhardt Robert W, Chen Fei, Ma Qingfeng, Lu Jie, Liu Yuqi, Wang Chunliang, Bai Xuesong, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.
Department of Neurology, Guangzhou Red Cross Hospital, Guangzhou, China.
J Neurointerv Surg. 2024 Feb 12;16(3):248-252. doi: 10.1136/jnis-2023-020336.
The significance of early venous filling (EVF) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is not fully understood. In this study, we aimed to investigate the impact of EVF after MT.
From January 2019 to May 2022, AIS patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b) after MT were retrospectively reviewed. EVF was evaluated on final digital subtraction angiography runs after successful recanalization and was categorized into phase subgroups (arterial phase and capillary phase) and pathway subgroups (cortical veins subgroup and thalamostriate veins subgroup), respectively. The impact of EVF subgroups on functional outcomes after successful recanalization were both investigated.
A total of 349 patients achieving successful recanalization after MT were included, including 45 patients in the EVF group and 304 patients in the non-EVF group. Multivariable logistic regression analysis showed the EVF group had a higher rate of intracranial hemorrhage (ICH; 66.7% vs 22%, adjusted odds ratio (aOR) 6.805, 95% CI 3.389 to 13.662, P<0.001), symptomatic ICH (sICH; 28.9% vs 4.9%, aOR 6.011, 95% CI 2.493 to 14.494, P<0.001) and malignant cerebral edema (MCE; 20% vs 6.9%, aOR 2.682, 95% CI 1.086 to 6.624, P=0.032) than the non-EVF group. Furthermore, the cortical veins subgroup of EVF had a higher rate of mortality than the thalamostriate veins subgroup (37.5% vs 10.3%, P=0.029).
EVF is independently associated with ICH, sICH and MCE after successful recanalization of MT, but not with favorable outcome and mortality.
急性缺血性卒中（AIS）机械取栓（MT）术后早期静脉充盈（EVF）的意义尚未完全明确。在本研究中，我们旨在探讨MT术后EVF的影响。
回顾性分析2019年1月至2022年5月期间MT术后成功再通（改良脑梗死溶栓评分（mTICI）≥2b）的AIS患者。在成功再通后的最终数字减影血管造影检查中评估EVF，并分别分为阶段亚组（动脉期和毛细血管期）和路径亚组（皮质静脉亚组和丘脑纹状体静脉亚组）。研究了成功再通后EVF亚组对功能结局的影响。
共纳入349例MT术后成功再通的患者，其中EVF组45例，非EVF组304例。多变量逻辑回归分析显示，与非EVF组相比，EVF组颅内出血（ICH）发生率更高（66.7%对22%，调整优势比（aOR）6.805，95%可信区间3.389至13.662，P<0.001）、症状性ICH（sICH）发生率更高（28.9%对4.9%，aOR 6.011，95%可信区间2.493至14.494，P<0.001）以及恶性脑水肿（MCE）发生率更高（20%对6.9%，aOR 2.682，95%可信区间1.086至6.624，P=0.032）。此外，EVF的皮质静脉亚组死亡率高于丘脑纹状体静脉亚组（37.5%对10.3%，P=0.029）。
MT成功再通后，EVF与ICH、sICH和MCE独立相关，但与良好结局和死亡率无关。
