脑卒中后血管内治疗致残的区域性贡献。

Q1 Medicine Interventional Neurology Pub Date : 2018-10-01 Epub Date: 2018-09-03 DOI:10.1159/000492400
Sunil A Sheth, Konark Malhotra, David S Liebeskind, Conrad W Liang, Albert J Yoo, Reza Jahan, Raul G Nogueira, Vitor Pereira, Jan Gralla, Greg Albers, Mayank Goyal, Jeffrey L Saver
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引用次数: 18

摘要

背景和目的:每个阿尔伯塔卒中项目早期CT评分(ASPECTS)区域对卒中后残疾的相对贡献可能因地区而异。确定各方面区域的相对权重可以改善患者对血管内卒中治疗(EST)的选择。方法:在联合接龙血流恢复联合取栓(SWIFT)、接龙血流恢复联合取栓用于急性血运重建术(STAR)和接龙血流恢复联合取栓作为主要血管内治疗(SWIFT PRIME)数据库中,我们确定了使用接龙支架回收器治疗的患者。使用24小时CT扫描,采用多变量有序回归来确定每个半球中每个ASPECTS区域对临床结果的相对贡献。使用回归的系数创建加权方面(wASPECTS),并将其与原始方面进行比较,以预测独立验证队列中90天修改后的兰金量表残疾结果。结果:342例接受EST治疗的患者中,平均年龄67岁,女性占57%,美国国立卫生研究院卒中量表(NIHSS)评分中位数为17 (IQR 13-20)。就诊时的中位评分为8 (IQR 7-10)。24小时CT上最常受累的ASPECTS区域为慢状核(70%)、岛核(55%)和尾状核(52%)。在多变量分析中,右半球M6 (β = 9.7)和M4 (β = 4.4)区域的保存最能预测良好的预后。对于左半球,M6 (β = 5.5), M5 (β = 4.1)和M3 (β = 3.1)产生了最大的参数估计,尽管它们没有达到统计学意义。纳入所有20个参数估计值的wASPECTS结果在独立队列中改善了对原始aspect的辨别(c统计量0.78 vs. 0.67,右半球)。结论:对于左右半球,与深层区域相比,保留高皮层区域与改善预后的关系更强。我们的研究结果支持在评估患者的EST时考虑相关方面区域的位置和相对权重。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Regional Contributions to Poststroke Disability in Endovascular Therapy.

Background and purpose: The relative contribution of each Alberta Stroke Program Early CT Score (ASPECTS) region to poststroke disability likely varies across regions. Determining the relative weights of each ASPECTS region may improve patient selection for endovascular stroke therapy (EST).

Methods: In the combined Solitaire Flow Restoration with the Intention for Thrombectomy (SWIFT), Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and Solitaire Flow Restoration with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) databases, we identified patients treated with the Solitaire stent retriever. Using 24-h CT scan, a multivariate ordinal regression was used to determine the relative contribution of each ASPECTS region to clinical outcome separately in each hemisphere. The coefficients from the regression were used to create a weighted ASPECTS (wASPECTS), which was compared with the original ASPECTS to predict 90-day modified Rankin Scale disability outcomes in an independent validation cohort.

Results: Among 342 patients treated with EST, the average age was 67 years, 57% were female, and the median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13-20). The median ASPECTS at presentation was 8 (IQR 7-10). The most commonly involved ASPECTS regions on 24-h CT were the lentiform nuclei (70%), insula (55%), and caudate (52%). In multivariate analysis, preservation of M6 (β = 9.7) and M4 (β = 4.4) regions in the right hemisphere was most strongly predictive of good outcome. For the left hemisphere, M6 (β = 5.5), M5 (β = 4.1), and M3 (β = 3.1) generated the greatest parameter estimates, though they did not reach statistical significance. A wASPECTS incorporating all 20 parameter estimates resulted in improved discrimination against the original ASPECTS in the independent cohort (C-statistic 0.78 vs. 0.67, right hemisphere).

Conclusions: For both right and left hemisphere, preservation of the high cortical regions was more strongly associated with improved outcomes compared to the deep regions. Our findings support taking into consideration the location and relative weightings of the involved ASPECTS regions when evaluating a patient for EST.

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Interventional Neurology
Interventional Neurology CLINICAL NEUROLOGY-
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