基于ASPECTS探讨急性缺血性卒中首过再灌注对功能结局的影响

The Impact of First Pass Reperfusion on Functional Outcome of Acute Stroke Based on ASPECTS

目的:探讨不同梗死体积的急性缺血性卒中患者经血管内机械取栓(EMT)治疗后首过再灌注(FPR)对功能结局的影响。方法:回顾性分析在本院接受EMT治疗的急性缺血性卒中患者200例,其中Alberta卒中项目早期CT评分(ASPECTS)≥6分100例,ASPECTS<6分100例。FPR定义为首次取栓时即达到改良脑梗死溶栓血流分级(mTICI)2b-3级。应用logistic回归分析分别分析不同梗死体积卒中患者EMT治疗后FPR对功能结局的影响。结果:ASPECTS≥6分卒中患者FPR组(n=59)治疗后颅内出血转化率(6.78%vs12.20%)、3个月致死率(11.86%vs21.95%)、3个月功能结局良好率(66.07%vs53.66%)与非FPR组(n=41)比较,差异均无统计学意义(P>0.05)。ASPECTS<6分卒中患者FPR组(n=56)治疗后颅内出血转化率(8.93%vs13.64%)、3个月致死率(14.29%vs20.45%)与非FPR组(n=44)比较,差异均无统计学意义(P>0.05),但FPR组患者治疗后3个月功能结局良好率明显高于非FPR组(46.43%vs25.00%),2组间差异有统计学意义(t=4.854,P=0.037)。logistic回归分析显示,FPR为预测急性缺血性卒中ASPECTS<6分患者良好功能结局的独立预测因子(OR=3.817,95%CI1.219~6.918;P=0.017),但FPR对急性缺血性卒中ASPECTS≥6分患者良好功能结局未能显示有统计学意义的预测价值(OR=1.482,95%CI0.734~2.716;P=0.325)。结论:FPR对急性缺血性卒中患者功能结局的影响依赖于梗死体积,当患者梗死体积较大(ASPECTS<6分)时,FPR对卒中功能结局的影响更显著。

Purpose:To investigate the impact of first pass reperfusion(FPR)on functional outcome of acute ischemic stroke(AIS)patients with different infarct volume after endovascular mechanical thrombectomy(EMT).Methods:A total of 200 cases of AIS patients who received EMT therapy in our hospital were analyzed retrospectively,of which 100 cases with Alberta stroke program early CT score(ASPECTS)≥6,100 cases with ASPECTS<6.The FPR was defined as achieving modified thrombolysis in cerebral infarction(m TICI)2 b-3 after a single pass of the device.Logistic regression analysis was performed to analyze the impact of FPR on the outcome in acute stroke with different infarct volume after EMT therapy.Results:For patients with ASPECTS≥6,the rate of intracranial hemorrhage(6.78%vs 12.20%),mortality rate at 3 months(11.86%vs 21.95%)and rate of good functional outcome at 3 months(66.07%vs 53.66%)in FPR group(n=59)were lower than those in non-FPR(n=41),while there were no significant differences between the two group(P>0.05).For patients with ASPECTS<6,the rate of intracranial hemorrhage(8.93%vs 13.64%),mortality rate at 3 months(14.29%vs 20.45%)were lower than those in non-FPR group(n=44),while there were no significant differences between the two group(P>0.05).However,the rate of good functional outcome at 3 months(46.43%vs 25.00%)in FPR group was higher than that in non-FPR group with significant difference(t=4.854,P=0.037).Logistic regression analysis showed that FPR was an independent predictor of good functional outcome in acute stroke patients with ASPECTS<6(OR=3.817,95%CI1.219-6.918;P=0.017).While FPR had no significant difference in predicting the good functional outcome in acute stroke patients with ASPECTS≥6(OR=1.482,95%CI 0.734-2.716;P=0.325).Conclusion:The effect of FPR on functional outcome is highly dependent on ASPECTS.When the infarct volume is large(ASPECTS<6),the effect of FPR on functional outcome is more prominent.