Yi Tingyu, Huo Xiaochuan, Lin Xiaohui, Wang Mengxing, Wu Yan-Min, Pan Zhinan, Zheng Xiufen, Lin Ding-Lai, Pan Yuesong, Miao Zhongrong, Chen Wenhuo
Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, Beijing, China.
Stroke Vasc Neurol. 2025 Jul 6. doi: 10.1136/svn-2024-003382.
Studies on futile recanalisation after endovascular therapy (EVT) for anterior circulation large vessel occlusion with large infarct were scarce. The present study aimed to explore the incidence and independent predictors of futile recanalisation in patients with large infarct.
This is a post-hoc analysis of the ANGEL-Alberta Stroke Program Early CT (ASPECT) trial. A favourable outcome was defined as a 90-day modified Rankin Scale score of 0-3; successful reperfusion was defined as extended thrombolysis in cerebral infarction 2b, 2c and 3 on final angiogram; and futile recanalisation was defined as unfavourable outcome despite successful reperfusion. We performed multivariate analysis to identify the predictors of futile recanalisation after EVT in patients with large infarct.
A total of 183 patients were included: 91 (49.7%) patients had futile recanalisation and 92 (51.3%) had meaningful recanalisation. In multivariable logistic regression analysis, nonmodifiable factors included older age (age ≥68 years, OR=3.4, 95%CI 1.5 to 7.7, p= 0.003), female sex (OR=2.78, 95%CI 1.28 to 7.27, p=0.01), higher National Institutes of Health Stroke Scale score (NIHSS ≥16, OR=3.1, 95%CI 1.2 to 8.3, p=0.035), diabetes (OR=3.1, 95%CI 1.2 to 8.3, p=0.017) and symptomatic intracranial haemorrhage (sICH) (OR=9.1, 95%CI 1.0 to 80.7, p=0.049), and modifiable factors included larger final infarct volume (FIV ≥174.7, OR=6.2, 95%CI 2.5 to 15.7, p<0.001) and postoperative respiratory failure (OR=14.1, 95%CI 1.6 to 124.8, p=0.018), which were independent predictors of futile recanalisation.
Futile recanalisation occurred in approximately half of patients who had an acute stroke with large infarct after EVT in the ANGEL-ASPECT trial. Nonmodifiable factors that included old age, high baseline NIHSS score, diabetes mellitus, sICH and large FIV, and modifiable factors that included respiratory failure were independent predictors of futile recanalisation after EVT for large ischaemic strokes. Stroke-related pneumonia control may improve prognosis.
关于血管内治疗（EVT）后前循环大血管闭塞合并大面积梗死患者出现无效再通的研究较少。本研究旨在探讨大面积梗死患者无效再通的发生率及独立预测因素。
这是对ANGEL-艾伯塔卒中项目早期CT（ASPECT）试验的事后分析。良好结局定义为90天改良Rankin量表评分为0-3分；成功再灌注定义为最终血管造影显示脑梗死溶栓扩展2b、2c和3级；无效再通定义为尽管成功再灌注但结局不佳。我们进行多变量分析以确定大面积梗死患者EVT后无效再通的预测因素。
共纳入183例患者：91例（49.7%）患者出现无效再通，92例（51.3%）患者出现有意义的再通。在多变量逻辑回归分析中，不可改变因素包括年龄较大（年龄≥68岁，OR=3.4，95%CI 1.5至7.7，p=0.003）、女性（OR=2.78，95%CI 1.28至7.27，p=0.01）、较高的美国国立卫生研究院卒中量表评分（NIHSS≥16，OR=3.1，95%CI 1.2至8.3，p=0.035）、糖尿病（OR=3.1，95%CI 1.2至8.3，p=0.017）和症状性颅内出血（sICH）（OR=9.1，95%CI 1.0至80.7，p=0.049），可改变因素包括最终梗死体积较大（FIV≥174.7，OR=6.2，95%CI 2.5至15.7，p<0.001）和术后呼吸衰竭（OR=14.1，95%CI 1.6至1
