Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan.
Department of Neurology, Yuncheng Central Hospital, Shanxi Province, Yuncheng, China.
Neurologist. 2024 Nov 1;29(6):311-316. doi: 10.1097/NRL.0000000000000574.
Whether patients with infarct volume ≥150 mL could benefit from endovascular thrombectomy (EVT) remains unclear.
Patients (n=104) with anterior circulation Alberta Stroke Program Early Computed Tomography Score <6 were screened for infarct volume ≥150 mL using the Pullicino formula × (1-22%). The following were compared with the baseline at 90 days: the modified Rankin scale score (mRS) ≤3, mortality rate, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours, and modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b between the EVT and drug therapy (DT) groups.
In patients with infarct volumes ≥150 mL, mRS≤3 at 90 days was higher in the EVT group than in the DT group [adjusted odds risk (aOR), 5.52; 95% CI: 1.10-28.24, P =0.04), and mTICI ≥2b at 82.8%. Intracranial hemorrhage within 48 hours occurred in 7 (24.1%) patients in the EVT group and 5 (14.7%) in the DT group (aOR, 0.75; 95% CI: 0.16-3.46; P =0.71). Older age (aOR, 0.94; 95% CI: 0.90-0.99, P =0.01), EVT treatment (aOR, 4.51; 95% CI: 1.60-12.78, P =0.01), and infarct volume ≥150 mL (aOR, 0.11; 95% CI: 0.04-0.31, P <0.01) were significantly associated with patient prognosis.
Patients with infarct volume ≥150 mL who received EVT had a higher proportion of mRS≤3 compared with those who received DT. However, there was no statistically significant difference in intracranial hemorrhage and death between the groups. EVT, smaller infarct volume, and younger age were associated with a good prognosis. The findings require large sample data verification.
对于梗死体积≥150ml 的患者，血管内血栓切除术（EVT）是否获益仍不清楚。
对前循环 Alberta Stroke Program Early Computed Tomography Score＜6 的患者进行筛选，使用 Pullicino 公式×（1-22%）计算梗死体积≥150ml。比较 EVT 组和药物治疗（DT）组在 90 天的以下情况：改良 Rankin 量表评分（mRS）≤3、死亡率、症状性颅内出血和 48 小时内任何颅内出血，以及 EVT 与 DT 组之间的改良脑梗死溶栓（mTICI）≥2b。
在梗死体积≥150ml 的患者中，EVT 组 90 天时 mRS≤3 的比例高于 DT 组[调整优势比（aOR），5.52；95%可信区间：1.10-28.24，P=0.04]，mTICI≥2b 的比例为 82.8%。EVT 组 7 例（24.1%）患者和 DT 组 5 例（14.7%）患者在 48 小时内发生颅内出血（aOR，0.75；95%可信区间：0.16-3.46；P=0.71）。年龄较大（aOR，0.94；95%可信区间：0.90-0.99，P=0.01）、EVT 治疗（aOR，4.51；95%可信区间：1.60-12.78，P=0.01）和梗死体积≥150ml（aOR，0.11；95%可信区间：0.04-0.31，P＜0.01）与患者预后显著相关。
与接受 DT 治疗的患者相比，接受 EVT 治疗的梗死体积≥150ml 的患者 mRS≤3 的比例更高。然而，两组之间在颅内出血和死亡率方面无统计学差异。EVT、较小的梗死体积和较年轻的年龄与良好的预后相关。这些发现需要大样本数据验证。
