Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke.
Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke.
复制标题
DOI：
10.1161/strokeaha.108.521054
复制
发表时间：
2008-12
期刊：
影响因子：
8.3
通讯作者：
Savitz SI
中科院分区：
文献类型：
--
作者：
Barreto AD;Albright KC;Hallevi H;Grotta JC;Noser EA;Khaja AM;Shaltoni HM;Gonzales NR;Illoh K;Martin-Schild S;Campbell MS 3rd;Weir RU;Savitz SI
研究已经确定了急性缺血性中风患者的血管再通与临床结果改善之间的关系；然而，动脉内血栓的大小尚未得到常规评估。该研究的目的是确定动脉内血栓负荷对动脉内治疗（IAT）和临床结果的影响。对我们的 IAT 卒中数据库进行回顾性审查，包括手术时间、血管再通、有症状的颅内出血、不良结局（出院时改良 Rankin 量表评分≥4）和死亡率。改良的心肌梗死溶栓血栓等级分为 0 至 3 级（无凝块或中度血栓，<2 血管直径）与 4 级（大血栓，> 2 血管直径）。收集了 135 名血栓分级患者的数据。与 0 至 3 级患者相比，4 级患者的美国国立卫生研究院卒中量表基线中位评分较高（19 vs 17，P=0.012）。与 0 至 3 级相比（76% vs 53%，P=0.005），4 级血栓需要更长（中位、范围）的 IAT 时间（分别为 113、37 至 415 分钟 vs 74、22 至 215 分钟；P<0.001），机械血栓破坏率（导丝、血管成形术、圈套器、支架或 Merci 回收器）更高。 4 级与 0 至 3 级的症状性颅内出血率（6.6% vs 4.1%，P=0.701）或再通率（50% vs 61%，P=0.216）没有差异。根据年龄、基线美国国立卫生研究院卒中量表评分和受累动脉进行调整后的多变量分析显示，4 级血栓与不良预后独立相关（比值） 比率=2.4； 95% CI，1.06 至 5.57； P=0.036）和死亡率（比值比=4.0；95% CI，1.2 至 13.2；P=0.023）。根据改良的心肌梗死溶栓标准测量的高血栓等级可能是导致不良临床结果的危险因素。
Studies have established a relation between recanalization and improved clinical outcome in acute ischemic stroke patients; however, intra-arterial clot size has not been routinely assessed. The aim of the study was to determine the impact of intra-arterial thrombus burden on intra-arterial treatment (IAT) and clinical outcome. A retrospective review of our IAT stroke database included procedure time, recanalization, symptomatic intracranial hemorrhage, poor outcome (modified Rankin Scale score ≥4 at discharge), and mortality. The modified Thrombolysis in Myocardial Infarction thrombus grade was dichotomized into grades 0 to 3 (no clot or moderate thrombus, <2 vessel diameters) versus grade 4 (large thrombus, >2 vessel diameters). Data were collected on 135 patients with thrombus grading. The baseline median National Institutes of Health Stroke Scale score was higher in patients of grade 4 compared with grades 0 to 3 (19 vs 17, P=0.012). Grade 4 thrombi required longer (median, range) times for IAT (113, 37 to 415 minutes vs 74, 22 to 215 minutes, respectively; P<0.001) and higher rates of mechanical clot disruption (wire, angioplasty, snare, stent, or Merci retriever) compared with grades 0 to 3 (76% vs 53%, P=0.005). There were no differences in rates of symptomatic intracranial hemorrhage (6.6% vs 4.1%, P=0.701) or recanalization (50% vs 61%, P=0.216) in grade 4 versus grades 0 to 3. Multivariate analysis adjusted for age, baseline National Institutes of Health Stroke Scale score, and artery of involvement showed that grade 4 thrombi were independently associated with poor outcome (odds ratio=2.4; 95% CI, 1.06 to 5.57; P=0.036) and mortality (odds ratio=4.0; 95% CI, 1.2 to 13.2; P=0.023). High thrombus grade as measured by the modified Thrombolysis in Myocardial Infarction criteria may be a risk factor that contributes to poor clinical outcome.