Evaluation of prognosis of patients with acute anterior circulation large vessel occlusive stroke treated with mechanical thrombectomy by early CT score of Alberta stroke program with plain CT
10.3760/cma.j.cn112149-20250106-00008
- VernacularTitle:平扫CT的阿尔伯塔卒中计划早期CT评分区域净摄水率评估急性前循环大血管闭塞性卒中机械取栓患者的预后
- Author:
Zehua LU
1
;
Yujie JIN
;
Xiaofeng JIN
;
Chengjun GENG
Author Information
1. 解放军联勤保障部队第九〇四医院放射科，无锡 214044
- Publication Type:Journal Article
- Keywords:
Tomography, X-ray computed;
Net water intake;
Acute large vessel occlusive stroke
- From:
Chinese Journal of Radiology
2025;59(5):505-510
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the value of Alberta stroke program early CT Score (ASPECTS) regional net water intake (NWU) based on plain CT in evaluating the neurological outcome of patients with acute large vessel occlusive stroke (ALVOS) after mechanical thrombectomy.Methods:The study was a prospective cross-sectional study. The clinical and imaging data of patients with ALVOS who underwent mechanical thrombectomy in the 904 Hospital of the PLA Joint Service Support Force from June 2022 to June 2024 were prospectively collected. Clinical data analysis included age, gender distribution, National Institutes of Health Stroke Scale (NIHSS) score and Glasgow Coma Scale (GCS) score at admission. All patients underwent plain CT and CT angiography (CTA). Automated processing software quantified ischemic brain edema by calculating ASPECTS and measuring the ASPECTS regional NWU rate (CT-ASPECTS-NWU) based on plain CT. Cerebral collateral circulation was assessed using CTA images. According to the modified Rankin Scale score of patients with mechanical thrombectomy 90 days after the telephone follow-up, 0-2 points were defined as good neurological outcome, and 3-6 points were defined as poor neurological outcome. Independent samples t test, Mann-Whitney U test and χ2 test were used to analyze the differences of clinical and imaging indicators between patients with good and poor neurological outcome, indicators with statistically significant differences were included in multivariate logistic regression analysis to screen out the independent influencing factors that predicted the neurological outcome of patients with ALVOS after mechanical thrombectomys. The efficacy of related indicators to predict neurological outcomes after mechanical thrombectomy in patients with ALVOS was evaluated using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) calculated. Results:A total of 122 patients with ALVOS were included, including 101 patients with good neurological outcome and 21 patients with poor neurological outcome after mechanical thrombectomy. There were statistically significant differences in preoperative GCS score, collateral circulation status, NIHSS score at admission, preoperative ASPECTS and CT-ASPECTS-NWU between patients with good neurological outcome and patients with poor neurological outcome ( P<0.05). Multivariate logistic regression analysis showed that the status of collateral circulation ( OR=3.450, 95% CI 1.158-10.277, P=0.026), preoperative ASPECTS ( OR=0.510, 95% CI 0.274-0.952, P=0.034) and CT-ASPECTS-NWU ( OR=2.131, 95% CI 1.301-3.493, P=0.003) were independent predictors of neurological outcome in patients with ALVOS after mechanical thrombectomy. ROC curve analysis showed that CT-ASPECTS-NWU had the highest predictive value, with an AUC of 0.881, a sensitivity of 85.7%, a specificity of 85.1%, and an optimal cutoff value of 7.55. Conclusion:CT-ASPECTS-NWU demonstrates high diagnostic value in evaluating the neurological outcome of patients with ALVOS after mechanical thrombectomy, and can provide an objective imaging biomarker to guide clinical decision-making.
