Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients
Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients
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DOI：
10.1161/strokeaha.118.021685
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发表时间：
2018-11-01
期刊：
影响因子：
8.3
通讯作者：
Fischer, Urs
中科院分区：
文献类型：
--
作者：
Mosimann, Pascal J.;Kaesmacher, Johannes;Fischer, Urs
背景和目的持续成功的再灌注是急性缺血性卒中良好临床结局的重要预后因素。我们的目的是确定发病率，临床影响，早期再闭塞后，最初成功的血栓切除术在一个前瞻性coherent.Methods共711中风患者成功再灌注（改良脑梗死溶栓，2b/3），随后在24至48小时的磁共振或计算机断层扫描血管造影包括在内。采用多因素Logistic回归分析评估相关因素和临床影响。结果显示为校正比值比（aOR）和95% CI。介入后血管造影控制运行的额外的成像结果的准确性的改善进行了评估的曲线下area under the curve.Results早期再闭塞观察711例成功再灌注患者中的16例（2.3%; 95%CI，1.1-3.3;中位数延迟：20小时）。提示性预测因素是入院时血小板升高（aOR，1.01; 95% CI，1.01-1.02），卒中前功能依赖（aOR，7.12; 95% CI，1.49-34.03），以及吐司分类中未确定或其他特定发病机制的卒中（aOR，7.19; 95%CI，1.10-47.05和aOR，36.50; 95%CI，4.47-298.11）。当将血栓切除术部位的残留栓塞碎片或狭窄纳入逻辑回归模型时，再闭塞和未再闭塞患者之间的区分显著改善（曲线下面积，0.955 vs 0.854; P=0.023）。早期再闭塞是90天时不良结局的独立预测因素（改良兰金量表2的aOR为0.13; 95%CI为0.03-0.57）。结论成功机械血栓切除术后48小时内早期再闭塞是罕见的，但与不良结局相关。入院时血小板高且血栓切除部位残留栓塞碎片或狭窄的患者再闭塞风险高，在仔细重新评估最后一次血管造影运行后可以预防或纠正。
Background and Purpose Sustained successful reperfusion is an important prognostic factor for good clinical outcome in acute ischemic stroke. We aimed to identify the prevalence, clinical impact, and predictors of early reocclusion after initially successful thrombectomies within a prospective cohort.Methods A total of 711 stroke patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b/3) followed with magnetic resonance or computed tomographic angiography at 24 to 48 hours were included. Multivariable logistic regression analysis was used to evaluate associated factors and clinical impact. Results are displayed as adjusted odds ratio (aOR) and 95% CI. Improvement in accuracy of additional imaging findings on angiography control runs after the intervention was evaluated by area under the curve.Results Early reocclusion was observed in 16 of 711 successfully reperfused patients (2.3%; 95% CI, 1.1-3.3; median delay: 20 hours). Suggestive predictors were higher platelets on admission (aOR, 1.01; 95% CI, 1.01-1.02), prestroke functional dependence (aOR, 7.12; 95% CI, 1.49-34.03), and stroke of undetermined or other specified pathogenesis in the TOAST classification (aOR, 7.19; 95% CI, 1.10-47.05 and aOR, 36.50; 95% CI, 4.47-298.11, respectively). When implementing residual embolic fragments or stenosis at the thrombectomy site into the logistic regression model, discrimination between patients with and without reocclusion improved significantly (area under the curve, 0.955 versus 0.854; P=0.023). Early reocclusion was an independent predictor of unfavorable outcome at 90 days (aOR for modified Rankin Scale 2, 0.13; 95% CI, 0.03-0.57).Conclusions Early reocclusion within 48 hours after successful mechanical thrombectomy is rare but associated with poor outcome. Patients with high platelets on admission and residual embolic fragments or stenosis at the thrombectomy site are at high risk for reocclusion, which may be prevented or corrected after carefully re-evaluating the last angiographic run.