Zhou Bo, Gong Haozhi, Li Jiazheng, Yang Jinjian, Yang Bin, Gao Peng, Chen Yanfei, Wang Yabing, Chen Jian, Chen Fei, Wang Tao, Jiao Liqun
Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China.
Eur J Med Res. 2025 Jul 11;30(1):614. doi: 10.1186/s40001-025-02705-1.
Endovascular treatment (EVT) is among the first line therapies for symptomatic intracranial atherosclerotic stenosis (sICAS) patients, while post-EVT stroke hinders its efficacy. Thromboelastography (TEG), shows promise in predicting stroke events, yet research gaps exist regarding the role of TEG in post-EVT sICAS patients. This study adopts a retrospective case-control research method to explore the effectiveness of TEG in predicting stroke events after EVT.
Patients receiving EVT and a dual antiplatelet regimen for sICAS between September 1, 2020, and April 30, 2023, at Xuanwu Hospital, Capital Medical University, Beijing, were enrolled in this study. TEG parameters were measured 7 days after dual antiplatelet regimen. Post-EVT strokes are defined as newly onset neurologic impairment and radiology changes after surgery. Multivariable logistic regression models were constructed to predict postoperative stroke occurrence.
A total of 561 patients remained eligible for analysis, including 29 (5.2%) and 18 (3.2%) patients experienced ischemic strokes and hemorrhagic strokes after EVT. Multivariable analysis showed that ADP%, a TEG parameter, was an independent predictor for post-EVT ischemic events (OR = 0.642, 95% CI 0.425-0.971, P = 0.036). Logistic regression model that includes TEG parameters shows better predictive performance (ROC-AUC = 0.74) than the model including only baseline information (ROC-AUC = 0.70).
In people with sICAS, 25% decreased ADP% may be associated with higher post-EVT ischemic stroke risk. The integration of TEG parameters may enhance the accuracy of predicting post-EVT ischemic stroke.
血管内治疗（EVT）是有症状颅内动脉粥样硬化狭窄（sICAS）患者的一线治疗方法之一，而EVT后卒中会影响其疗效。血栓弹力图（TEG）在预测卒中事件方面显示出前景，但关于TEG在EVT后sICAS患者中的作用仍存在研究空白。本研究采用回顾性病例对照研究方法，探讨TEG在预测EVT后卒中事件中的有效性。
选取2020年9月1日至2023年4月30日在北京首都医科大学宣武医院接受EVT及双联抗血小板治疗的sICAS患者纳入本研究。在双联抗血小板治疗7天后测量TEG参数。EVT后卒中定义为术后新出现的神经功能缺损和影像学改变。构建多变量逻辑回归模型以预测术后卒中的发生。
共有561例患者符合分析条件，其中29例（5.2%）和18例（3.2%）患者在EVT后发生缺血性卒中和出血性卒中。多变量分析显示，TEG参数ADP%是EVT后缺血事件的独立预测因素（OR = 0.642，95%CI 0.425 - 0.971，P = 0.036）。包含TEG参数的逻辑回归模型显示出比仅包含基线信息的模型更好的预测性能（ROC-AUC = 0.74）（ROC-AUC = 0.70）。
在sICAS患者中，ADP%降低25%可能与EVT后缺血性卒中风险较高相关。TEG参数的整合可能提高预测EVT后缺血性卒中的准确性。
