Merlino Giovanni, Pez Sara, Sartor Roberto, Kuris Fedra, Tereshko Yan, Nesi Lorenzo, Lorenzut Simone, Janes Francesco, Sponza Massimo, Gavrilovic Vladimir, Marotti Nicola, Pellegrin Andrea, Dapoto Annarita, Vit Alessandro, Pauro Alessandro, Gigli Gian Luigi, Valente Mariarosaria
Stroke Unit, Department of Head-Neck and Neuroscience, Udine University Hospital, Udine, Italy.
Clinical Neurology, Udine University Hospital, Udine, Italy.
Front Neurol. 2023 May 19;14:1170215. doi: 10.3389/fneur.2023.1170215. eCollection 2023.
Mechanical thrombectomy (MT) is the first line treatment in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Approximately half of patients treated with MT does not have a favorable outcome 3 months after stroke. The aim of this study was to identify predictors of futile recanalization (FR) in patients with LVO treated with MT.
A retrospective analysis of consecutive patients with acute ischemic stroke due to anterior circulation LVO who underwent MT. Patients with a TICI score of 2b or 3 were included. We distinguished two groups, FR and meaningful recanalization (MR), according to patients' disability three months after stroke (FR: mRS score > 2; MR: mRS score < 2).
We enrolled 238 patients (FR, = 129, 54.2%; MR, = 109, 45.8%). Age (OR 1.05, 95% CI 1.01-1.09, = 0.012), female sex (OR 2.43, 95% CI 1.12-5.30, = 0.025), stress hyperglycemia, as measured by the GAR index, (OR 1.17, 95% CI 1.06-1.29, = 0.002), NIHSS at admission (OR 1.15, 95% CI 1.07-1.25, = 0.001) and time from symptoms onset to MT (OR 1.01, 95% CI 1.00-1.01, = 0.020) were independent predictors of FR. The AUC for the model combining age, female sex, GAR index, NIHSS at admission and time from symptoms onset to MT was 0.81 (95% CI 0.76-0.87; < 0.001). The optimal GAR index cut-off score to predict FR was 17.9.
FR is common after MT. We recognized older age, female sex and baseline NIHSS as non-modifiable predictors of FR. On the other hand, time from symptoms onset to MT and stress hyperglycemia were modifiable pre- and post-MT factors, respectively. Any effort should be encouraged to reduce the impact of these modifiable predictors.
机械取栓术（MT）是治疗因大血管闭塞（LVO）导致的急性缺血性卒中（AIS）的一线治疗方法。接受MT治疗的患者中约有一半在卒中后3个月没有良好的预后。本研究的目的是确定接受MT治疗的LVO患者无效再通（FR）的预测因素。
对因前循环LVO接受MT治疗的急性缺血性卒中连续患者进行回顾性分析。纳入TICI评分2b或3分的患者。根据患者卒中后3个月的残疾情况，我们区分了两组，即FR组和有意义再通（MR）组（FR组：mRS评分>2；MR组：mRS评分<2）。
我们纳入了238例患者（FR组129例，占54.2%；MR组109例，占45.8%）。年龄（OR 1.05，95%CI 1.01-1.09，P = 0.012）、女性（OR 2.43，95%CI 1.12-5.30，P = 0.025）、用GAR指数测量的应激性高血糖（OR 1.17，95%CI 1.06-1.29，P = 0.002）、入院时的美国国立卫生研究院卒中量表（NIHSS）评分（OR 1.15，95%CI 1.07-1.25，P = 0.001）以及从症状发作到MT的时间（OR 1.01，95%CI 1.00-1.01，P = 0.020）是FR的独立预测因素。结合年龄、女性、GAR指数、入院时的NIHSS评分以及从症状发作到MT的时间的模型的曲线下面积（AUC）为0.81（95%CI 0.76-0.87；P<0.001）。预测FR的最佳GAR指数截断值为17.9。
MT术后FR很常见。我们认识到年龄较大、女性和基线NIHSS评分是FR不可改变的预测因素。另一方面，从症状发作到MT的时间和应激性高血糖分别是MT术前和术后可改变的因素。应鼓励做出任何努力来减少这些可改变的预测因素的影响。
