脑静脉引流与急性前循环大血管闭塞机械取栓术首通效应的关系

Association of cerebral venous outflow with first-pass effect in anterior circulation large vessel occlusion accepted mechanical thrombectomy

目的探讨行机械取栓术治疗的急性前循环大血管闭塞患者中,通过术前CT血管造影(CTA)评估的脑静脉引流情况与首通效应(FPE)之间的关系。方法回顾性连续纳入徐州医科大学附属医院神经内科自2018年7月至2021年6月收治的急性前循环大血管闭塞患者,所有患者均行机械取栓术治疗并完成术前CTA检查。使用皮质静脉显影评分(COVES)对基线CTA中脑静脉引流进行评估,根据首次机械取栓后闭塞血管的再通情况将患者分为FPE组和非FPE组,比较2组患者一般资料、临床特征、影像学资料和手术相关数据;将单因素分析中P<0.1的变量纳入多因素Logistic回归模型,以明确COVES评分和FPE之间的关系,同时通过受试者工作特征(ROC)曲线评估COVES评分对FPE的预测价值。结果研究共纳入143例患者,其中FPE组患者52例,非FPE组患者91例。与非FPE组患者比较,FPE组患者的COVES评分较高、脑静脉引流良好(COVES评分≥3分)患者的比例较高、核心梗死体积较小、股动脉穿刺至血管再通时间较短,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,调整患者的基线美国国立卫生研究院卒中量表(NIHSS)评分、核心梗死体积和股动脉穿刺至血管再通时间等协变量后,COVES评分仍然和急性前循环大血管闭塞机械取栓FPE相关(OR=0.730,95%CI:0.567~0.940,P=0.015)。ROC曲线显示COVES评分联合其他因素(COVES评分+基线NIHSS评分+核心梗死体积+股动脉穿刺至血管再通时间)模型预测FPE的曲线下面积为0.757(95%CI:0.672~0.841,P<0.001),对应的敏感性为61.5%,特异性为78.0%。结论在接受机械取栓治疗的急性前循环大血管闭塞患者中,良好的脑静脉引流是FPE的独立预测因素。

Objective To explore the association of cerebral venous outflow assessed by CT angiography(CTA)with first pass effect(FPE)in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy(MT).Methods A retrospective analysis was performed;patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology,Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled.Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score(COVES).Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT.General information,clinical features,radiological data,and surgery-related data between the 2 groups of patients were collected and compared.Significant variables(P<0.1)from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE.Predictive value of COVES in FPE was assessed using receiver operating characteristic(ROC)curve.Results Out of the 143 patients enrolled in this study,52 were into the FPE group and 91 were into the non-FPE group.Compared with the non-FPE group,the FPE group had higher COVES scores,higher proportion of patients with good cerebral venous drainage(COVES≥3),smaller core infarct volume,and shorter time from femoral artery puncture to vessel recanalization,with significant differences(P<0.05).Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores,core infarct volume,and time from femoral artery puncture to vessel recanalization(OR=0.730,95%CI:0.567-0.940,P=0.015).ROC curve demonstrated that the combined model of COVES with aforementioned factors(COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization)had an area under the curve of 0.757(95%CI:0.672-0.841,P<0.001),with sensitivity of 61.5%and specificity of 78.0%.Conclusion Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT.