Risk factors of unfavorable prognosis for anterior circulation schemic stroke patients with large ischemic core after endovascular treatment
10.3760/cma.j.cn114798-20210904-00675
- VernacularTitle:大梗死核心前循环急性缺血性卒中患者血管内治疗预后的影响因素分析
- Author:
Ling LI
1
;
Yuhui CHEN
;
Kunpeng CHEN
;
Guoxuan WANG
;
Guogeng WU
;
Ruoyao CAO
;
Yao LU
;
Lei ZHANG
;
Juan CHEN
Author Information
1. 北京医院 国家老年医学中心 国家卫生健康委北京老年医学研究所 国家卫生健康委老年医学重点实验室 中国医学科学院老年医学研究院，北京 100730
- Keywords:
Stroke;
Acute ischemic stroke;
Endovascular treatment;
Collateral circulation;
Clot burden score
- From:
Chinese Journal of General Practitioners
2022;21(2):161-168
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the prognostic value of the collateral status and clot burden score based on four-dimensional computed tomography angiography(4D CTA)in anteriorcir culation is chemics troke patients with large ischemic core after endovascular treatment.Methods:Clinical and imaging data of 36 anterior circulation ischemic stroke patients with large infarct core (infarct core≥50.0 ml) after endovascular treatment at our institution from March 2016 to September 2020 were retrospectively reviewed. According to the modified Rankin Scale (mRS) score, patients were divided into the good outcome (mRS score 0-2) and poor outcome (mRS score 3-6) groups. Mann-Whitney U and Fisher tests were used to compare the 4D CTA collateral circulation score, clot burden score, and baseline clinical data between the good and poor outcome groups. Multivariate logistic regression was used to analyze the risk factors associated with the poor outcome (mRS score 3-6) and mortality in patients with large infarct core stroke. Finally, based on the 90-day outcome, a ROC curve was used to obtain the cut-off values for poor prognosis (mRS 3-6) and death, respectively. Results:Ten patients (27.8%) had good outcome and 26 (72.2%) had poor outcome. The patients in the poor outcome group had older median age, higher blood glucose, lower 4D CTA collateral circulation score, lower clot burden score, larger infarct core volume, and higher hemorrhagic transformation and brain hernia (all P<0.05). Multivariate logistic regression showed that the poor collateral circulation score on 4D CTA( OR=0.18, 95% CI: 0.03-0.99, P<0.05)and clot burden score( OR=0.64, 95% CI: 0.44-0.93, P<0.05) were independent predictors of the poor prognosis. The ROC curves revealed that the cut-off value of infarct core for distinguishing between good prognosis and poor prognosis was 63.7 ml, while that for distinguishing between survival and death was 130.3 ml. Conclusions:Endovascular treatment may improve the prognosis of patients with large infarct core of anterior circulation is chemic stroke if the patients have good 4D CTA collateral circulation score and high clot burden score.
