基于ASPECTS脑梗死部位与机械取栓术后无效复流相关性的多中心临床研究  

A multicenter clinical study on the correlation between cerebral infarction location determined based on ASPECTS and futile recanalization after mechanical thrombectomy

作　　者：李钊硕 钟海龙 周腾飞 贺迎坤 李强 王子亮 朱良付 温昌明[2] 韩建峰[3] 魏立平 黄立安[5] 刘金朝 黎宏庄 蔡学礼[8] 关海涛[9] 顾建平[10] 王守春[11] 张育德[12] 龙友明[13] 南光贤[14] 李天晓 Li Zhaoshuo;Zhong Hailong;Zhou Tengfei;He Yingkun;Li Qiang;Wang Ziliang;Zhu Liangfu;Wen Changming;Han Jianfeng;Wei Liping;Huang Li′an;Liu Jinchao;Li Hongzhuang;Cai Xueli;Guan Haitao;Gu Jianping;Wang Shouchun;Zhang Yude;Long Youming;Nan Guangxian;Li Tianxiao(Department of Cerebrovascular Disease,He′nan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China;Department of Neurology,Nanyang Central Hospital,Nanyang 473000,China;Department of Neurology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710048,China;Department of Neurology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China;Department of Neurology,the First Affiliated Hospital of Ji′nan University,Guangzhou 510630,China;Department of Intervention,Puyang Oilfield General Hospital,Puyang 457000,China;Department of Neurology,Shunde Hospital of Southern Medical University,Foshan 528300,China;Department of Neurology,Lishui Central Hospital,Lishui 323000,China;Department of Neurology,the Third Affiliated Hospital of Guangzhou Medical Hospital,Guangzhou 510150,China;Department of Intervention,Nanjing First Hospital,Nanjing 210006,China;Department of Neurology,the First Affiliated Hospital of Jilin University,Changchun 130021,China;Department of Neurology,the First Affiliated Hospital of He′nan University of Science and Technology,Luoyang 471003,China;Department of Neurology,the Second Affiliated Hospital of Guangzhou Medical Hospital,Guangzhou 510260,China;Department of Neurology,the China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)脑血管病中心,郑州450003 [2]南阳市中心医院神经内科,南阳473000 [3]西安交通大学第一附属医院神经内科,西安710048 [4]郑州大学附属洛阳中心医院神经内科,洛阳471000 [5]暨南大学附属第一医院神经内科,广州510630 [6]濮阳市油田总医院介入科,濮阳457000 [7]南方医科大学顺德医院神经内科,佛山528300 [8]丽水市中心医院神经内科,丽水323000 [9]广州医科大学附属第三医院神经内科,广州510150 [10]南京市第一医院介入科,南京210006 [11]吉林大学白求恩第一医院神经内科,长春130021 [12]河南科技大学第一附属医院神经内科,洛阳471003 [13]广州医科大学附属第二医院神经内科,广州510260 [14]吉林大学中日联谊医院神经内科,长春130033

出　　处：《中华神经外科杂志》2022年第8期794-799,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202102036,SBGJ202002001)。

摘　　要：目的:探讨基于Alberta卒中项目早期CT评分(ASPECTS)定义的脑梗死部位与机械取栓术后无效复流的相关性。方法:研究病例来源于河南省人民医院脑血管病中心等14家医院于2018年1月至2019年1月进行的采用机械取栓术治疗颈内动脉系统急性脑梗死的前瞻性、随机对照研究(Skyflow研究)。纳入取栓术后即刻扩展的脑梗死溶栓(eTICI)分级≥2b级、随访时间≥90 d的192例患者进行回顾性研究。根据术后90 d改良Rankin量表评分(mRS)将患者分为无效复流组(mRS≥3分)105例(54.7%)、有效复流组(mRS<3分)87例(45.3%)。根据ASPECTS评估的脑梗死部位,将患者分为M6区和非M6区梗死。采用单因素和多因素logistic回归模型分析基于ASPECTS的M6区脑梗死与无效复流的相关性。结果:105例无效复流组中,梗死灶位于M6区者占53.3%(56例);87例有效复流组中,梗死灶位于M6区者占36.8%(32例),差异有统计学意义(P=0.016)。多因素logistic回归分析结果显示,除原发性高血压(OR=1.78,95%CI:1.09~3.47)、术前美国国立卫生研究院卒中量表评分(OR=1.86,95%CI:1.24~2.77)和ASPECTS(OR=1.92,95%CI:1.22~3.16)、发病至再通时间(OR=2.65,95%CI:1.27~4.65)、术后eTICI分级2c~3级(OR=2.34,95%CI:1.32~3.54)外,梗死灶位于M6区也是影响取栓术后无效复流的重要因素(OR=2.25,95%CI:1.15~3.47),差异均有统计学意义(均P<0.05)。结论:基于ASPECTS评估的M6区脑梗死患者机械取栓术后发生无效复流的风险高。Objective To investigate the correlation between cerebral infarction location determined based on ASPECTS(The Alberta Stroke Program Early CT Score)and futile recanalization after mechanical thrombectomy.Methods The cases in this study were collected from a prospective,randomized controlled study of mechanical thrombectomy(Skyflow study)in the treatment of acute cerebral infarction of the internal carotid artery system conducted by 14 hospitals including the Department of Cerebrovascular Disease of He′nan Provincial People′s Hospital from January 2018 to January 2019.A retrospective study of 192 patients with extended thrombolysis in cerebral infarction(eTICI)grade≥2b immediately after thrombectomy and follow-up time≥90 days was performed.According to the modified Rankin scale score(mRS)at 90 days after operation,the patients were divided into futile recanalization(mRS≥3 points)group(105 cases,54.7%)and effective recanalization(mRS<3 points)group(87 cases,45.3%).Patients were divided into M6 and non-M6 infarction groups according to the location of cerebral infarction assessed by the ASPECTS system.Univariate and multivariate logistic regression models were used to analyze the correlation between ASPECTS-based M6 cerebral infarction and futile recanalization.Results Among the 105 patients in the futile recanalization group,53.3%(56 cases)had infarction located in the M6 area;in the 87 cases of effective recanalization group,36.8%(32 cases)had infarction located in the M6 area,and the difference was statistically significant(P=0.016).Multivariate logistic regression analysis showed that,in addition to the history of hypertension(OR=1.78,95%CI:1.09-3.47),preoperative NIHSS(National Institutes of Health Stroke Scale,OR=1.86,95%CI:1.24-2.77)and ASPECTS(OR=1.92,95%CI:1.22-3.16),time from onset to recanalization(OR=2.65,95%CI:1.27-4.65),postoperative eTICI 2c-3 grade(OR=2.34,95%CI:1.32-3.54),infarction located in the M6 area was also an important factor related to the futile recanalization after thrombectomy(

关 键 词：脑梗死 动脉闭塞性疾病 机械取栓术 无效复流 梗死部位 

分 类 号：R651.12[医药卫生—外科学]