Deguchi Ichiro, Osada Takashi, Nakagami Toru, Kohyama Shinya, Takahashi Shinichi
Departments of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, JPN.
Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, JPN.
Cureus. 2024 Feb 12;16(2):e54085. doi: 10.7759/cureus.54085. eCollection 2024 Feb.
Reperfusion therapy is typically performed in cases with acute cerebral infarction. Mechanical thrombectomy (MT) achieves superior recanalization and favorable outcomes. However, some patients have poor functional prognosis despite successful recanalization. We investigated factors affecting functional prognosis after MT with good reperfusion.
Among the 205 consecutive cases with ischemic stroke treated with MT at our center from January 1, 2019 to March 31, 2021, 168 with successful recanalization were included. Factors affecting early neurological improvement (ENI) and modified Rankin Scale (mRS) scores were reviewed retrospectively.
There were 93 (55%) cases with ENI and 75 (45%) without ENI. The times from onset to recombinant tissue-type plasminogen activator administration and recanalization in ENI cases were shorter than those in non-ENI cases. However, non-ENI cases had significantly higher Fazekas grades for white matter lesions. In multivariate analysis, the Fazekas grade was related to ENI (odds ratio [OR]=0.572, 95% confidence interval [CI]=0.345-0.948). The mRS score at discharge was 0-2 in 64 cases (good outcome) and 3-6 in 104 cases (poor outcome). Patients with a poor outcome had a significantly higher age, National Institutes of Health Stroke Scale (NIHSS) score, and Fazekas grade. Multivariate analysis revealed that the NIHSS score (OR=1.073, 95% CI=1.020-1.129) and Fazekas grade (OR=2.162, 95% CI=1.458-3.205) at hospitalization affected the mRS score at discharge.
There is a correlation of greater severity of white matter lesions with poorer ENI and clinical outcomes at discharge post-MT.
再灌注治疗通常用于急性脑梗死病例。机械取栓术（MT）能实现更好的血管再通并带来良好预后。然而，一些患者尽管血管成功再通，但其功能预后仍较差。我们研究了MT术后再灌注良好情况下影响功能预后的因素。
在2019年1月1日至2021年3月31日期间于我院中心接受MT治疗的205例连续缺血性卒中病例中，纳入168例血管成功再通的病例。回顾性分析影响早期神经功能改善（ENI）和改良Rankin量表（mRS）评分的因素。
有93例（55%）出现ENI，75例（45%）未出现ENI。ENI病例从发病到给予重组组织型纤溶酶原激活剂及血管再通的时间短于未出现ENI的病例。然而，未出现ENI的病例白质病变的 Fazekas分级显著更高。多因素分析显示，Fazekas分级与ENI相关（比值比[OR]=0.572，95%置信区间[CI]=0.345 - 0.948）。出院时mRS评分为0 - 2分的有64例（预后良好），3 - 6分的有104例（预后不良）。预后不良的患者年龄、美国国立卫生研究院卒中量表（NIHSS）评分及Fazekas分级显著更高。多因素分析显示，住院时的NIHSS评分（OR=1.073，95%CI=1.020 - 1.129）和Fazekas分级（OR=2.162，95%CI=1.458 - 3.205）影响出院时的mRS评分。
白质病变严重程度越高，MT术后ENI越差，出院时临床预后也越差，二者存在相关性。
