Objectives

Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy.

Material and methods

All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanalization was defined as Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Multivariable logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome.

Results

621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neurological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanalization (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome.

Conclusion

Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable outcome in patients with low ASPECTS.

中文翻译：

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艾伯塔省卒中计划早期计算机断层扫描评分 4-5 和 0-3 的缺血性卒中患者的血栓切除术：与良好结果相关的因素

目标

最近发表的 ANGEL-ASPECT 和 SELECT2 试验结果表明，艾伯塔省中风计划早期计算机断层扫描评分 (ASPECTS) 较低的中风患者可受益于机械血栓切除术。这项回顾性研究的目的是确定与 ASPECTS 为 4-5 和 0-3 的低患者接受机械血栓切除术的良好结局相关的因素。

材料与方法

对德国神经放射学会质量登记中报告的 2018 年至 2020 年间接受治疗的所有患者进行了分析。良好的结果定义为美国国立卫生研究院卒中量表(NIHSS) 评分低于 9 分。成功的再通定义为脑梗塞溶栓(mTICI) ≥ 2b。进行多变量逻辑回归分析以评估基线和治疗变量与良好结果的关联。

结果

分析包括 621 名患者，其中 495 名患者患有 ASPECTS 4-5，126 名患者患有 ASPECTS 0-3。在 ASPECTS 4-5 患者中，预后良好的患者入院时神经系统症状较轻，中位 NIHSS 为 15 比 18 (p<0.001)，觉醒中风的发生率较低（44% 比 81%，p<0.001） ，接受静脉溶解的频率更高（37% vs. 30%，p<0.001），更频繁地接受清醒镇静（29% vs. 16%，p<0.001），再通成功率更高（94% vs. 16%）。从腹股沟穿刺到再通的时间为 66% 及更低。在多变量回归分析中，入院时较低的 NIHSS（aOR 0.87，CI 0.89-0.91）和成功的再通（aOR 3.96，CI 2-8.56）与良好的结果相关。对于 ASPECTS 0-如图 3 所示，预后良好的患者入院时 NIHSS 中位数较低（16 比 18（p<0.001），通过次数较少（1 比 3，p=0.003），再通成功率较高（94% 比 66 ％，p<0.001）和从腹股沟穿刺到再通的时间较短。在多变量回归分析中，入院时较低的 NIHSS（aOR 0.87，CI 0.81-0.94）和成功的再通（aOR 11.19，CI 3.19-55.53）与有利相关。结果。

结论

低腹股沟穿刺的完全再通再通时间和低次数与低 ASPECTS 患者的良好结局相关。