基于ASPECTS脑梗死部位与机械取栓术后无效复流相关性的多中心临床研究

A multicenter clinical study on the correlation between cerebral infarction location determined based on ASPECTS and futile recanalization after mechanical thrombectomy

目的:探讨基于Alberta卒中项目早期CT评分(ASPECTS)定义的脑梗死部位与机械取栓术后无效复流的相关性。方法:研究病例来源于河南省人民医院脑血管病中心等14家医院于2018年1月至2019年1月进行的采用机械取栓术治疗颈内动脉系统急性脑梗死的前瞻性、随机对照研究(Skyflow研究)。纳入取栓术后即刻扩展的脑梗死溶栓(eTICI)分级≥2b级、随访时间≥90 d的192例患者进行回顾性研究。根据术后90 d改良Rankin量表评分(mRS)将患者分为无效复流组(mRS≥3分)105例(54.7%)、有效复流组(mRS<3分)87例(45.3%)。根据ASPECTS评估的脑梗死部位,将患者分为M6区和非M6区梗死。采用单因素和多因素logistic回归模型分析基于ASPECTS的M6区脑梗死与无效复流的相关性。结果:105例无效复流组中,梗死灶位于M6区者占53.3%(56例);87例有效复流组中,梗死灶位于M6区者占36.8%(32例),差异有统计学意义(P=0.016)。多因素logistic回归分析结果显示,除原发性高血压(OR=1.78,95%CI:1.09~3.47)、术前美国国立卫生研究院卒中量表评分(OR=1.86,95%CI:1.24~2.77)和ASPECTS(OR=1.92,95%CI:1.22~3.16)、发病至再通时间(OR=2.65,95%CI:1.27~4.65)、术后eTICI分级2c~3级(OR=2.34,95%CI:1.32~3.54)外,梗死灶位于M6区也是影响取栓术后无效复流的重要因素(OR=2.25,95%CI:1.15~3.47),差异均有统计学意义(均P<0.05)。结论:基于ASPECTS评估的M6区脑梗死患者机械取栓术后发生无效复流的风险高。

Objective To investigate the correlation between cerebral infarction location determined based on ASPECTS(The Alberta Stroke Program Early CT Score)and futile recanalization after mechanical thrombectomy.Methods The cases in this study were collected from a prospective,randomized controlled study of mechanical thrombectomy(Skyflow study)in the treatment of acute cerebral infarction of the internal carotid artery system conducted by 14 hospitals including the Department of Cerebrovascular Disease of He′nan Provincial People′s Hospital from January 2018 to January 2019.A retrospective study of 192 patients with extended thrombolysis in cerebral infarction(eTICI)grade≥2b immediately after thrombectomy and follow-up time≥90 days was performed.According to the modified Rankin scale score(mRS)at 90 days after operation,the patients were divided into futile recanalization(mRS≥3 points)group(105 cases,54.7%)and effective recanalization(mRS<3 points)group(87 cases,45.3%).Patients were divided into M6 and non-M6 infarction groups according to the location of cerebral infarction assessed by the ASPECTS system.Univariate and multivariate logistic regression models were used to analyze the correlation between ASPECTS-based M6 cerebral infarction and futile recanalization.Results Among the 105 patients in the futile recanalization group,53.3%(56 cases)had infarction located in the M6 area;in the 87 cases of effective recanalization group,36.8%(32 cases)had infarction located in the M6 area,and the difference was statistically significant(P=0.016).Multivariate logistic regression analysis showed that,in addition to the history of hypertension(OR=1.78,95%CI:1.09-3.47),preoperative NIHSS(National Institutes of Health Stroke Scale,OR=1.86,95%CI:1.24-2.77)and ASPECTS(OR=1.92,95%CI:1.22-3.16),time from onset to recanalization(OR=2.65,95%CI:1.27-4.65),postoperative eTICI 2c-3 grade(OR=2.34,95%CI:1.32-3.54),infarction located in the M6 area was also an important factor related to the futile recanalization after thrombectomy(OR=2.25,95%CI:1.15-3.47),and the difference was statistically significant(all P<0.05).Conclusion Patients with M6 region infarction based on ASPECTS have a higher risk of futile recanalization after mechanical thrombectomy.