Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS 5)?
Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS 5)?
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DOI：
10.1111/ene.13460
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发表时间：
2018-01-01
影响因子：
5.1
通讯作者：
Pierot, L.
中科院分区：
文献类型：
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作者：
Manceau, P. -F.;Soize, S.;Pierot, L.
背景和目的当弥散加权成像（DWI）病变超过给定体积时是否停止机械取栓尚未确定。我们的目的是确定有助于选择可能受益于血栓切除术的大 DWI 病变 [DWI-阿尔伯塔中风计划早期计算机断层扫描评分 (DWI-ASPECTS) 5] 患者的标记物。方法从 2010 年 5 月到 2016 年 11 月，82 名具有 DWI-ASPECTS 5 的急性缺血性中风患者（43 名男性，64.6±14.4 岁，美国国立卫生研究院中风量表） 18.4 5.4) 采用最先进的机械血栓切除术进行了研究。 28 名 (34%) 患者仅进行了血栓切除术，54 名 (66%) 患者进行了桥接治疗。再通定义为脑梗死评分为 2B-3 的溶栓，显着出血转化为实质血肿 2 型（欧洲合作急性卒中研究 3 分类）。对 3 个月时具有良好（改良 Rankin 量表 0-2）和较差（改良 Rankin 量表 3-6）神经学结果的患者之间的治疗前变量进行比较。结果总体而言，28 名患者 (34%) 在 3 个月时取得了良好的神经学结果。与非血管再通治疗者相比，血管再通治疗者显着更有可能取得良好的预后（61% vs. 7.3%，P < 0.0001），死亡率较低（24% vs. 49%，P = 0.03），并且 2 型实质血肿发生率相似（9.8% vs. 7.3%，P = 1）。回归模型确定 DWI-ASPECTS >2 [比值比 (OR) 6.93； 95% 置信区间 (CI) 1.05-45.76，P = 0.04）、血糖 6.8 mmol/l（OR 4.05；95% CI 1.09-15.0，P = 0.03）和溶栓（OR 3.67；95% CI 1.04-12.9，P = 0.04）作为良好神经功能的独立预测因子结论 在 DWI-ASPECTS 5 患者中，三分之二的患者在通过最先进的血栓切除术进行再通时获得了良好的神经学结果，而只有四分之一的非再通者获得了类似的结果。良好神经学结果的治疗前标志物为 DWI-ASPECTS >2、静脉溶栓和血糖 6.8 mmol/l。
Background and purposeWhether to withhold mechanical thrombectomy when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is undetermined. Our aim was to identify markers that will help to select patients with large DWI lesions [DWI-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) 5] that may benefit from thrombectomy.MethodsFrom May 2010 to November 2016, 82 acute ischaemic stroke patients with DWI-ASPECTS 5 (43 men, 64.6 14.4 years, National Institutes of Health Stroke Scale 18.4 5.4) treated with state-of-the-art mechanical thrombectomy were studied. Thrombectomy alone was performed in 28 (34%) and bridging therapy in 54 (66%) patients. Recanalization was defined as a thrombolysis in cerebral infarction score 2B-3 and significant hemorrhagic transformation as parenchymal haematoma type 2 (European Cooperative Acute Stroke Study 3 classification). Pretreatment variables were compared between patients with a good (modified Rankin Scale 0-2) and a poor (modified Rankin Scale 3-6) neurological outcome at 3 months.ResultsOverall, 28 patients (34%) achieved good neurological outcome at 3 months. Recanalizers were significantly more likely to achieve good outcome (61% vs. 7.3%, P < 0.0001), had lower mortality (24% vs. 49%, P = 0.03) and similar rates of parenchymal haematoma type 2 (9.8% vs. 7.3%, P = 1) compared to non-recanalizers. Regression modelling identified DWI-ASPECTS >2 [odds ratio (OR) 6.93; 95% confidence interval (CI) 1.05-45.76, P = 0.04), glycaemia 6.8 mmol/l (OR 4.05; 95% CI 1.09-15.0, P = 0.03) and thrombolysis (OR 3.67; 95% CI 1.04-12.9, P = 0.04) as independent predictors of good neurological outcome.ConclusionsIn patients with DWI-ASPECTS 5, two-thirds of patients experienced good neurological outcome when recanalized by state-of-the-art thrombectomy, whilst only one in 14 non-recanalizers achieved similar outcomes. Pretreatment markers of good neurological outcomes were DWI-ASPECTS >2, intravenous thrombolysis and glycaemia 6.8 mmol/l.