Neuro Interventional Surgery, Sarasota Memorial Hospital, Sarasota, FL, USA.
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
J Neurointerv Surg. 2024 Nov 22;16(12):1268-1274. doi: 10.1136/jnis-2023-021046.
Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2).
Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B.
We identified 58 patients who presented with ASPECTS 0-2 and underwent MT. Median age was 74.0 (66.3-80.0) years, 30 (51.7%) were females, and 16 (27.6%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 34 (64.2%) patients and stent retriever was used in 8 (15.1%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 41.4%, 31% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes.
This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.
最近的临床试验表明，对于大血管闭塞（LVO）和大梗死核心的患者，机械血栓切除术（MT）仍可能有效。在这项研究中，我们评估了 ASPECTS 评分 0-2 的 LVO 患者接受 MT 的结果。
对卒中取栓和动脉瘤登记（STAR）数据库进行了检索。我们纳入了颅内颈内动脉（ICA）或大脑中动脉 M1 段闭塞且梗死核心非常大（ASPECTS 评分 0-2）的患者。以改良 Rankin 量表评分（mRS）0-3 为 90 天 MT 后良好结局的定义标准。成功再通定义为改良脑梗死溶栓分级（mTICI）评分≥2B。
共纳入 58 例 ASPECTS 评分 0-2 并接受 MT 的患者。中位年龄为 74.0（66.3-80.0）岁，30 例（51.7%）为女性，16 例（27.6%）患者接受静脉组织型纤溶酶原激活剂治疗。闭塞部位无差异（p=0.57）。34 例（64.2%）患者采用抽吸血栓切除术，8 例（15.1%）患者采用支架取栓术。ASPECTS 评分 0-2 的患者死亡率为 41.4%，90 天 mRS 评分 0-3 者占 31%，90 天 mRS 评分 5-6 者占≥70 岁患者的 66.67%。多变量分析显示，年龄、入院时国立卫生研究院卒中量表评分和再通（mTICI≥2B）与良好结局独立相关。
这项多中心回顾性队列研究表明，对于 ASPECTS 评分 0-2 的特定患者，MT 可能有益。
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