目的:血管内治疗(EVT)是由于前循环大血管闭塞(LVO)引起的急性缺血性卒中(AIS)患者最成功的治疗方法。然而,无效再通(FR)严重影响这些患者的预后。这项研究的目的是研究AIS患者EVT后FR的预测因素。
方法:前瞻性纳入2020年6月至2022年10月因前循环LVO而诊断为AIS并接受EVT的患者。EVT后的FR被定义为90天预后差(改良的Rankin量表[mRS]评分≥3),尽管成功实现了再灌注(改良的脑梗死溶栓[mTICI]分类2b-3)。所有纳入患者分为对照组(mRS评分<3)和FR组(mRS评分≥3)。人口特征,合并症(高血压,糖尿病,心房颤动,吸烟,等。),卒中特定数据(NIHSS评分,ASPECT评分和闭塞部位),程序数据(治疗类型[直接血栓切除术与桥接血栓切除术],血管再通程度[mTICI],手术持续时间和开始-再通时间),实验室指标(淋巴细胞计数,中性粒细胞计数,单核细胞计数,C反应蛋白,中性粒细胞与淋巴细胞比率[NLR],单核细胞与高密度脂蛋白比值[MHR],淋巴细胞与单核细胞比率[LMR],淋巴细胞与C反应蛋白比[LCR],淋巴细胞与高密度脂蛋白比率[LHR],总胆固醇和甘油三酯。)比较两组。采用多因素logistic回归分析探讨EVT后FR的独立预测因素。
结果:本研究共纳入196例患者,其中57例患者纳入对照组,139例患者纳入FR组.年龄,高血压和糖尿病患者的比例,NIHSS评分中位数,CRP水平,程序持续时间,FR组的中性粒细胞计数和NLR高于对照组.淋巴细胞计数,LMR,FR组LCR低于对照组。血小板计数无显著差异,单核细胞计数,总胆固醇,甘油三酯,HDL,LDL,性别,吸烟,心房颤动,闭塞部位的百分比,发病-再通时间,比较两组患者的ASPECT评分及治疗类型。多因素logistic回归分析显示,NLR与EVT后FR独立相关(OR=1.37,95CI=1.005~1.86,P=0.046)。
结论:这项研究表明,高NLR与前循环LVO导致的AIS患者的FR风险相关。这些发现可能有助于临床医生确定哪些AIS患者在EVT后发生FR的风险较高。本研究可为上述人群的干预提供理论依据。
OBJECTIVE: Endovascular therapy (EVT) is the most successful treatment for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. However, futile recanalization (FR) seriously affects the prognosis of these patients. The aim of this study was to investigate predictors of FR after EVT in patients with AIS.
METHODS: Patients diagnosed with AIS due to anterior circulation LVO and receiving EVT between June 2020 and October 2022 were prospectively enrolled. FR after EVT was defined as a poor 90-day prognosis (modified Rankin Scale [mRS] score ≥ 3) despite achieving successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] classification of 2b-3). All included patients were categorized into control group (mRS score < 3) and FR group (mRS score ≥ 3). Demographic characteristics, comorbidities (hypertension, diabetes, atrial fibrillation, smoking, etc.), stroke-specific data (NIHSS score, ASPECT score and site of occlusion), procedure data (treatment type [direct thrombectomy vs. bridging thrombectomy], degree of vascular recanalization [mTICI], procedure duration time and onset-recanalization time), laboratory indicators (lymphocytes count, neutrophils count, monocytes count, C-reactive protein, neutrophil-to-lymphocyte ratio [NLR], monocyte-to-high-density lipoprotein ratio [MHR], lymphocyte-to-monocyte ratio [LMR], lymphocyte-to-C-reactive protein ratio [LCR], lymphocyte-to-high-density lipoprotein ratio[LHR], total cholesterol and triglycerides.) were compared between the two groups. Multivariate logistic regression analysis was performed to explore independent predictors of FR after EVT.
RESULTS: A total of 196 patients were included in this study, among which 57 patients were included in the control group and 139 patients were included in the FR group. Age, proportion of patients with hypertension and diabetes mellitus, median NIHSS score, CRP level, procedure duration time, neutrophil count and NLR were higher in the FR group than in the control group. Lymphocyte count, LMR, and LCR were lower in the FR group than in the control group. There were no significant differences in platelet count, monocytes count, total cholesterol, triglycerides, HDL, LDL, gender, smoking, atrial fibrillation, percentage of occluded sites, onset-recanalization time, ASPECT score and type of treatment between the two groups. Multivariate logistic regression analysis demonstrated that NLR was independently associated with FR after EVT (OR = 1.37, 95%CI = 1.005-1.86, P = 0.046).
CONCLUSIONS: This study demonstrated that high NLR was associated with a risk of FR in patients with AIS due to anterior circulation LVO. These findings may help clinicians determine which patients with AIS are at higher risk of FR after EVT. Our study can provide a theoretical basis for interventions in the aforementioned population.