颅内血管弯曲在远端血管闭塞取栓术中的预后价值。

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-06-26 DOI:10.1177/23969873251350124

Pere Canals, Alvaro García-Tornel, Giulio Maria Fiore, Marc Rodrigo-Gisbert, Blanca Sastre, Jordi Mayol, Jesús David González Riveros, Marc Ribo

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引用次数: 0

摘要

导言：评估机械取栓（MT）治疗中/远端血管闭塞（MDVO）的试验中性结果表明，这些患者需要更好的选择标准。弯曲的血管解剖结构可能会对MT的疗效和安全性产生负面影响。患者和方法：纳入2017年1月至2024年9月在本中心连续行MT的大脑中动脉(MCA)-MDVO （M2/M3）患者。基线cta使用内部血管分析框架进行半自动分析。提取颈内动脉（ICA）弯曲指数（TI）和MCA的解剖特征。经静脉溶栓给药和起病至穿刺时间调整后的Logistic回归评估了解剖特征与治疗疗效和安全性终点的关联。主要终点是完全再通（最终eTICI 2c/3）和症状性颅内出血（sICH）。结果：纳入213例患者，年龄81岁（IQR 72 ~ 87），女性51.2%。MCA弯曲长度（aOR 0.48 [95%CI 0.27-0.86], p = 0.013）、MCA- ti （aOR 0.77 [0.60-0.98], p = 0.032）和ICA-TI （aOR 0.59 [0.36-0.96], p = 0.034）与较低的完全再通概率相关。ICA-TI （aOR 0.51 [0.31-0.84], p = 0.008）和平均MCA直径（aOR 0.34 [0.13-0.90], p = 0.030）与首次再通几率降低相关。中动脉平均直径大与良好功能预后的可能性较低相关（aOR 0.30 [0.09-0.96], p = 0.042）。关于安全性终点，闭塞处直径较大与蛛网膜下腔出血相关（aOR 4.04 [1.03-15.87], p = 0.046），而MCA弯曲长度（aOR 2.47 [1.24-4.92], p = 0.010）与蛛网膜下腔出血相关。讨论：血管解剖特征的自动评估可以预测MT治疗卒中合并MCA-MDVO患者的安全性和有效性。这些特征作为未来MCA-MDVO临床试验纳入标准的价值值得探讨。结论：颅内血管弯曲与MDVO患者取栓效果差有关。

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Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.

Introduction: Neutral results from trials assessing mechanical thrombectomy (MT) for medium/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.

Patients and methods: Consecutive patients with middle cerebral artery (MCA)-MDVO (M2/M3) who underwent MT at our center between January 2017 and September 2024 were included. Baseline CTAs were semi-automatically analyzed using an in-house vascular analysis framework. The internal carotid artery (ICA) tortuosity index (TI) and anatomical features of the MCA were extracted. Logistic regression adjusted for intravenous thrombolysis administration and onset-to-puncture time evaluated associations of anatomical features with treatment efficacy and safety endpoints. Primary endpoints were complete recanalization (final eTICI 2c/3) and symptomatic intracranial hemorrhage (sICH).

Results: 213 patients (81 years IQR 72-87, 51.2% female) were included. MCA bending length (aOR 0.48 [95%CI 0.27-0.86], p = 0.013), MCA-TI (aOR 0.77 [0.60-0.98], p = 0.032) and ICA-TI (aOR 0.59 [0.36-0.96], p = 0.034) were associated with lower probability of complete recanalization. ICA-TI (aOR 0.51 [0.31-0.84], p = 0.008) and mean MCA diameter (aOR 0.34 [0.13-0.90], p = 0.030) correlated with decreased odds of first-pass recanalization. Large mean MCA diameter was associated with lower likelihood of excellent functional outcome (aOR 0.30 [0.09-0.96], p = 0.042). Regarding safety endpoints, larger diameter at occlusion was associated with sICH (aOR 4.04 [1.03-15.87], p = 0.046), while MCA bending length (aOR 2.47 [1.24-4.92], p = 0.010) was linked to subarachnoid hemorrhage.

Discussion: Automatic evaluation of anatomical vascular features may predict safety and efficacy of MT in stroke patients with MCA-MDVO. The value of these features as inclusion criteria for future MCA-MDVO clinical trials should be explored.

Conclusion: Intracranial vascular tortuosity is associated to poor thrombectomy outcomes in patients with MDVO.

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.