Futile reperfusion of endovascular treatment for acute anterior circulation large vessel occlusion in the ANGEL-ACT registry

被引:15
作者
Yang, XinGuang [1 ,2 ]
Sun, Dapeng [1 ]
Huo, Xiaochuan [1 ,5 ]
Raynald, Raynald [1 ]
Jia, BaiXue [1 ]
Tong, Xu [1 ]
Wang, Anxin [3 ]
Ma, Ning [1 ]
Gao, Feng [1 ]
Mo, Dapeng [1 ]
Miao, Zhongrong [1 ,4 ]
机构
[1] Capital Med Univ, Beijing Tiantan Hosp, Dept Intervent Neuroradiol, Beijing, Peoples R China
[2] Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Dept Neurol, Guangzhou, Guangdong, Peoples R China
[3] Capital Med Univ, Beijing Tiantan Hosp, China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China
[4] Capital Med Univ, Beijing Tiantan Hosp, Dept Intervent Neuroradiol, Beijing 100070, Peoples R China
[5] Capital Med Univ, Beijing Tiantan Hosp, Dept Intervent Neuroradiol, 119 South 4th Ring West Rd, Beijing 100070, Peoples R China
关键词
Stroke; Thrombectomy; ACUTE ISCHEMIC-STROKE; HYPERGLYCEMIA; MANAGEMENT; PATIENT; CARE;
D O I
10.1136/jnis-2022-019874
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
BackgroundSome patients with large vessel occlusion (LVO) still cannot achieve functional independence despite successful reperfusion after endovascular treatment (EVT), named futile reperfusion. We aimed to explore the incidence and predictors of futile reperfusion of EVT for anterior circulation LVO in the Chinese population based on a nationwide prospective multicenter registry. MethodsWe selected patients from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) registry. Successful reperfusion was defined as modified Treatment In Cerebral Ischemia (mTICI) 2b-3 after EVT, and functional independence was defined as 90-day modified Rankin Scale (mRS) 0-2. A multivariable regression model was performed to identify the independent predictors of futile reperfusion in anterior circulation LVO patients. ResultsA total of 1158 anterior circulation LVO patients were included in our study. 600 of the 1158 patients (51.8%) suffered futile reperfusion. Age >= 69 (adjusted OR (aOR) 1.69, 95% CI 1.21 to 2.35, P=0.002), baseline National Institutes of Health Stroke Scale (NIHSS) >= 14 (aOR 2.36, 95% CI 1.71 to 3.27, P<0.001), baseline serum glucose >= 6.5 mmol/L (aOR 1.73, 95% CI 1.27 to 2.36, P=0.001), drip and ship (aOR 1.56, 95% CI 1.11 to 2.18, P=0.011), and general anesthesia (aOR 2.28, 95% CI 1.66 to 3.14, P<0.001) were associated with a high risk of futile reperfusion in the anterior LVO patients after EVT, whereas baseline Alberta Stroke Program Early CT Score (ASPECTS) >= 8 (aOR 0.65, 95% CI 0.47 to 0.91, P=0.011) and complete reperfusion (aOR 0.62, 95% CI 0.43 to 0.89, P=0.010) were associated with a low risk of futile reperfusion in the anterior LVO patients after EVT. ConclusionsIn the ANGEL-ACT registry, 51.8% of anterior circulation LVO patients suffered futile reperfusion after EVT. Age >= 69 years, baseline NIHSS >= 14, baseline serum glucose >= 6.5 mmol/L, drip and ship, general anesthesia, baseline ASPECTS <8, and incomplete reperfusion were the independent predictors of futile reperfusion.
引用
收藏
页码:e363 / e368
页数:6
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