Lu Jialiang, Lu Ziwei, Li Ye, Li Fangcun, Feng Yuxuan, Dang Meijuan, Yang Yang, Tang Fan, Li Tao, Zhao Lili, Jian Yating, Wang Xiaoya, Zhang Lei, Fan Hong, Zhang Guilian
Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China.
Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
Stroke Vasc Neurol. 2024 Sep 11. doi: 10.1136/svn-2024-003355.
This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER).
Preoperative ASPECTS and region of infarction were recorded before recanalisation. Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale; a score>2 was defined as poor outcome. Secondary outcomes included postprocedural cerebral oedema, intracranial haemorrhage (ICH) and symptomatic ICH.
Among the 86 patients included, 90-day outcome was poor in 30 (34.9%) and 40 experienced cerebral oedema (46.5%). Multivariate logistic regression models showed that lenticular nucleus infarction (OR 19.61-26.00, p<0.05), admission diastolic blood pressure (OR 1.07-1.08, p<0.05), preprocedural National Institutes of Health Stroke Scale (OR 1.96-2.05, p<0.001) and haemorrhagic transformation (OR 14.99-18.81, p<0.05) were independent predictors of poor 90-day outcome. The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73. M2 region infarction (OR 26.07, p<0.001) and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade (OR 0.16, p=0.001) were independent predictors of postprocedural cerebral oedema. The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64. Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH.
Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER.
本研究回顾性调查了在接受血管内再通术（ER）的有症状非急性颈内动脉或大脑中动脉闭塞患者中，阿尔伯塔卒中项目早期CT评分（ASPECTS）特定区域的梗死是否与临床结局相关。
在再通术前记录术前ASPECTS和梗死区域。术后90天使用改良Rankin量表评估临床结局；评分>2被定义为不良结局。次要结局包括术后脑水肿、颅内出血（ICH）和有症状ICH。
在纳入的86例患者中，30例（34.9%）90天结局不良，40例出现脑水肿（46.5%）。多因素逻辑回归模型显示，豆状核梗死（比值比19.61 - 26.00，p<0.05）、入院舒张压（比值比1.07 - 1.08，p<0.05）、术前美国国立卫生研究院卒中量表评分（比值比1.96 - 2.05，p<0.001）和出血性转化（比值比14.99 - 18.81，p<0.05）是90天不良结局的独立预测因素。以豆状核梗死作为不良结局预测指标的受试者工作特征曲线下面积为0.73。M2区域梗死（比值比26.07，p<0.001）和低美国介入和治疗神经放射学会/介入放射学会侧支循环分级（比值比0.16，p = 0.001）是术后脑水肿的独立预测因素。以M2区域梗死作为脑水肿预测指标的受试者工作特征曲线下面积为0.64。有或无术后ICH或有症状ICH的患者之间梗死区域无显著差异。
在接受ER的非急性前循环大动脉闭塞患者中，豆状核梗死和M2区域梗死分别是90天不良结局和术后脑水肿的独立预测因素。
