大面积梗死急性缺血性卒中患者血管内治疗的有效性和安全性研究

Efficacy and Safety of Endovascular Therapy for Acute Ischemic Stroke Patients with Large Infarct Core

目的观察低ASPECTS评分的大面积梗死患者血管内治疗的有效性和安全性,并探讨预后的影响因素。方法从急性缺血性卒中血管内治疗关键技术及急救流程改进研究-前瞻性、多中心、登记研究(endovascular treatment key technique and emergency work flow improvement of acute ischemic stroke,ANGEL-ACT)中筛选接受血管内治疗,且ASPECTS/后循环ASPECTS(post-circulation ASPECTS,pcASPECTS)<6分的大面积脑梗死患者,分析影响患者预后的因素。有效性终点为术后90 d预后良好(mRS 0~3分),安全性终点包括术后24 h内症状性颅内出血(symptomatic intracranial hemorrhage,sICH)和术后90 d全因死亡。结果共纳入121例患者,其中男性89例(73.55%),中位年龄62.0(54.0~72.0)岁,失访6例,纳入统计分析的共115例患者。术后90 d预后良好53例(46.09%),基线低NIHSS(OR 0.908,95%CI 0.841~0.980,P=0.0130)和闭塞血管再通成功(OR 13.676,95%CI 1.396~134.004,P=0.0247)是术后90 d预后良好的独立预测因子。术后24 h内发生sICH 21例(18.26%),穿刺至再通时间长(OR 1.009,95%CI 1.002~1.017,P=0.0163)和病变血管合并串联狭窄(OR 4.202,95%CI 1.457~12.119,P=0.0079)是术后24 h内sICH的独立预测因子。术后90 d全因死亡23例(20.00%),基线高NIHSS(OR 1.089,95%CI 1.014~1.170,P=0.0186)和术后24 h内sICH(OR 4.688,95%CI 1.382~15.898,P=0.0132)是术后90 d全因死亡的独立预测因子。结论大面积梗死的急性缺血性卒中患者接受血管内治疗虽然风险较高,但术前严格地筛选低NIHSS患者,术中尽量获得闭塞血管再通成功能够使患者获益。

Objective To investigate the efficacy and safety of endovascular therapy(EVT)for acute ischemic stroke(AIS)patients with ASPECTS 0-5,and explore the possible influencing factors for the outcomes.Methods This study enrolled the AIS patients with ASPECTS/post-circulation ASPECTS(pcASPECTS)<6 points and large infarct core who received EVT from a nationwide multicenter stroke registry study-the endovascular treatment key technique and emergency work flow improvement of acute ischemic stroke(ANGEL-ACT)study.The primary endpoint was 90-day good outcome,defined as mRS≤3.The safety endpoints included symptomatic intracranial hemorrhage(sICH)within 24 hours after the procedure and all-cause mortality within 90 days.The influencing factors for the outcomes were analyzed.Results A total of 121 patients were included in this study,with the median age of 62.0(54.0-72.0)years old and 89 males(73.55%),6 patients were lost to follow-up,and finally a total of 115 patients were included in statistical analysis.The rate of 90-day good outcome was 46.09%(53/115),the low admission NIHSS(OR 0.908,95%CI 0.841-0.980,P=0.0130)and successful recanalization(OR 13.676,95%CI 1.396-134.004,P=0.0247)were independent predictors for 90-day good outcome.The rate of 24-hour sICH was 18.26%(21/115),the long puncture-to-reperfusion time(OR 1.009,95%CI 1.002-1.017,P=0.0163)and the occlusion combined with tandem stenosis(OR 4.202,95%CI 1.457-12.119,P=0.0079)were independent predictors for 24-hour sICH.The 90-day all-cause mortality was 20.00%(23/115),the high admission NIHSS(OR 1.089,95%CI 1.014-1.170,P=0.0186)and 24-hour sICH(OR 4.688,95%CI 1.382-15.898,P=0.0132)were independent predictors for 90-day all-cause mortality.Conclusions The risk of EVT for patients with large infarct core was high,whereas they can also benefit from the endovascular reperfusion therapy after careful screening the eligible patients with low NIHSS.