介入治疗后脑高信号阿尔伯塔卒中项目早期CT评分预测缺血性卒中患者的有症状颅内出血

Postinterventional cerebral hyperdensities Alberta Stroke Program Early CT Score predicts symptomatic intracranial hemorrhage in patients with ischemic stroke

目的利用阿尔伯塔卒中项目早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS)评估急性前循环大血管闭塞性卒中患者介入治疗后脑高信号(postinterventional cerebral hyperdensities,PCHDs)的分布特点,并探讨其对有症状颅内出血(symptomatic intracranial hemorrhage,sICH)的预测价值。方法连续回顾性纳入2018年1月至2020年12月期间在东莞市人民医院卒中中心接受血管内机械血栓切除术(endovascular mechanical thrombectomy,EMT)的急性前循环大血管闭塞性卒中患者。收集临床、影像学和随访资料。对血管内治疗后即时PCHDs-ASPECTS进行分析,应用多变量logistic回归分析及受试者工作特征(receiver operator characteristic,ROC)曲线探讨其对sICH的预测价值。结果研究纳入161例患者,年龄(62.5±12.5)岁,其中男性115例(71.4%),基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(13.6±5.6)分;66例(41.0%)出现PCHDs,35例(21.7%)发生sICH。sICH组基线NIHSS评分、重度卒中患者构成比、尝试取栓次数和PCHDs检出率显著高于非sICH组,而弥散加权成像-ASPECTS和PCHDs-ASPECTS显著低于非sICH组(P均<0.05)。多变量logistic回归分析显示,PCHDs与sICH呈显著独立正相关(优势比6.036,95%置信区间1.45~25.123;P=0.013),PCHDs-ASPECTS与sICH呈显著独立负相关(优势比0.70,95%置信区间0.496~0.992;P=0.045)。ROC分析显示,PCHDs-ASPECTS预测sICH的曲线下面积为0.832(P<0.05),其截断值为8分时,敏感性和特异性分别为74.3%和83.3%。结论在接受EMT治疗的急性前循环大血管闭塞性卒中患者中,术后即时出现PCHDs是发生sICH的独立预测因素,PCHDs-ASPECTS可早期预测EMT后sICH风险。

Objective To evaluate the distribution characteristics of postinterventional cerebral hyperdensities(PCHDs)in patients with acute anterior circulation large vessel occlusive stroke after interventional therapy using the Alberta Stroke Program Early CT Score(ASPECTS)and to investigate its predictive value for symptomatic intracranial hemorrhage(sICH).Methods Consecutive patients with acute anterior circulation large vessel occlusive stroke underwent endovascular mechanical thrombectomy(EMT)in the Stroke Center of Dongguan People's Hospital from January 2018 to December 2020 were retrospectively enrolled.The clinical,imaging and follow-up data were collected.The immediate PCHDs-ASPECTS after endovascular therapy were analyzed.Multivariate logistic regression analysis and receiver operator characteristic(ROC)curve were used to investigate its predictive value for sICH.Results A total of 161 patients were enrolled in the study,including 115 males(71.4%).The baseline National Institutes of Health Stroke Scale(NIHSS)score was 13.6±5.6;66 patients(41.0%)developed PCHDs and 35(21.7%)had sICH.The baseline NIHSS score,the proportion of patients with severe stroke,the number of retrieval attempts and the detection rate of PCHDs in the sICH group were significantly higher than those in the non-sICH group,while diffusion weighted imaging-ASPECTS and PCHDs-ASPECTS were significantly lower than those in the non-sICH group(all P<0.05).Multivariate logistic regression analysis showed that PCHDs had a significant independent positive correlation with sICH(odds ratio 6.036,95%confidence interval 1.45-25.123;P=0.013),and PCHDs-ASPECTS had a significant independent negative correlation with sICH(odds ratio 0.70,95%confidence interval 0.496-0.992;P=0.045).ROC analysis showed that the area under the curve predicted by PCHDs-ASPECTS was 0.832(P<0.05).When its cut-off value was 8 points,the sensitivity and specificity were 74.3%and 83.3%respectively.Conclusions In patients with acute anterior circulation large vessel occlusive stroke treated with EMT,the immediate postoperative PCHDs is an independent predictor of sICH,and PCHDs-ASPECTS can early predict the risk of sICH after EMT.