大面积梗死患者无效再通的预测因素：ANGEL-ASPECT试验的事后分析。

IF 2.6 1区医学

Journal of Investigative Medicine Pub Date : 2025-07-06 DOI:10.1136/svn-2024-003382

Tingyu Yi, Xiaochuan Huo, Xiaohui Lin, Mengxing Wang, Yan-Min Wu, Zhinan Pan, Xiufen Zheng, Ding-Lai Lin, Yuesong Pan, Zhongrong Miao, Wenhuo Chen

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引用次数: 0

摘要

背景：对于前循环大血管闭塞伴大面积梗死的血管内治疗（EVT）后无效再通的研究很少。本研究旨在探讨大面积梗死患者无效再通的发生率和独立预测因素。方法：这是对ANGEL-Alberta卒中项目早期CT （ASPECT）试验的事后分析。90天的修正兰金量表评分为0-3分为有利结果；再灌注成功定义为最终血管造影显示脑梗死2b、2c和3期溶栓延长；再通无效定义为再灌注成功后的不良结果。我们进行了多变量分析，以确定大面积梗死患者EVT后无效再通的预测因素。结果：共纳入183例患者：91例（49.7%）无效再通，92例（51.3%）有意义再通。在多变量logistic回归分析中，不可改变的因素包括年龄较大（年龄≥68岁，OR=3.4, 95%CI 1.5 ~ 7.7, p= 0.003）、女性（OR=2.78, 95%CI 1.28 ~ 7.27, p=0.01）、美国国立卫生研究院卒中量表评分较高（NIHSS≥16，OR=3.1, 95%CI 1.2 ~ 8.3, p=0.035）、糖尿病（OR=3.1, 95%CI 1.2 ~ 8.3, p=0.017）和症状性颅内出血（siich）（OR=9.1, 95%CI 1.0 ~ 80.7, p=0.049），可改变的因素包括较大的最终梗死体积(FIV≥174.7，OR=6.2, 95%CI 2.5 - 15.7，结论：在ANGEL-ASPECT试验中，大约一半的急性卒中伴大面积梗死患者在EVT后发生无效再通。包括老年、高基线NIHSS评分、糖尿病、sICH和大FIV在内的不可改变因素，以及包括呼吸衰竭在内的可改变因素是大缺血性脑卒中EVT后无效再通的独立预测因素。卒中相关性肺炎控制可改善预后。

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Predictors of futile recanalisation in patients with large infarct: a post-hoc analysis of the ANGEL-ASPECT trial.

Background: Studies on futile recanalisation after endovascular therapy (EVT) for anterior circulation large vessel occlusion with large infarct were scarce. The present study aimed to explore the incidence and independent predictors of futile recanalisation in patients with large infarct.

Methods: This is a post-hoc analysis of the ANGEL-Alberta Stroke Program Early CT (ASPECT) trial. A favourable outcome was defined as a 90-day modified Rankin Scale score of 0-3; successful reperfusion was defined as extended thrombolysis in cerebral infarction 2b, 2c and 3 on final angiogram; and futile recanalisation was defined as unfavourable outcome despite successful reperfusion. We performed multivariate analysis to identify the predictors of futile recanalisation after EVT in patients with large infarct.

Results: A total of 183 patients were included: 91 (49.7%) patients had futile recanalisation and 92 (51.3%) had meaningful recanalisation. In multivariable logistic regression analysis, nonmodifiable factors included older age (age ≥68 years, OR=3.4, 95%CI 1.5 to 7.7, p= 0.003), female sex (OR=2.78, 95%CI 1.28 to 7.27, p=0.01), higher National Institutes of Health Stroke Scale score (NIHSS ≥16, OR=3.1, 95%CI 1.2 to 8.3, p=0.035), diabetes (OR=3.1, 95%CI 1.2 to 8.3, p=0.017) and symptomatic intracranial haemorrhage (sICH) (OR=9.1, 95%CI 1.0 to 80.7, p=0.049), and modifiable factors included larger final infarct volume (FIV ≥174.7, OR=6.2, 95%CI 2.5 to 15.7, p<0.001) and postoperative respiratory failure (OR=14.1, 95%CI 1.6 to 124.8, p=0.018), which were independent predictors of futile recanalisation.

Conclusions: Futile recanalisation occurred in approximately half of patients who had an acute stroke with large infarct after EVT in the ANGEL-ASPECT trial. Nonmodifiable factors that included old age, high baseline NIHSS score, diabetes mellitus, sICH and large FIV, and modifiable factors that included respiratory failure were independent predictors of futile recanalisation after EVT for large ischaemic strokes. Stroke-related pneumonia control may improve prognosis.

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来源期刊

Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL

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0.00%

发文量

111

期刊介绍： Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.