机械血栓切除术后"成功"再通的前循环卒中患者的转归:TICI 3与TICI 2b比较

目的 探讨急性前循环卒中机械取栓后脑梗死溶栓(Thrombolysis in Cerebral Infarction, TICI)再通分级TICI 2b与TICI 3患者的转归差异.方法 回顾性纳入机械血栓切除术后"成功"再通的急性前循环卒中患者,并分为TICI 2b(几乎完全再通)组和TICI 3(完全再通)组.转归良好定义为发病后3个月时改良Rankin量表评分0~2分.结果 共纳入83例患者.TICI 2b级38例(45.8%),TICI 3级45例(54.2%);49例(59.0%)转归良好,34例(40.9%)转归不良.TICI 3组转归良好率显著高于TICI 2b组(68.9%对47.4%;χ2=3.946,P=0.047).多变量logistic回归分析显示,校正年龄、高血压、糖尿病、基线收缩压、三酰甘油、静脉溶栓、ASITN/SIR侧支循环分级后,TICI 3级是发病后3个月时转归良好的独立预测因素优势比(odds ratio, OR)3.759,95%可信区间(confidence interval, CI)1.098~12.871;P=0.035],而基线NIHSS评分较高(OR 0.820,95% CI 0.715~0.941;P=0.005)和空腹血糖较高(OR 0.610,95% CI 0.410~0.906;P=0.014)是发病后3个月时转归不良的独立预测因素.结论 机械血栓切除术后"成功"再通的急性前循环缺血性卒中患者转归存在差异,TICI 3的患者显著优于TICI 2b的患者.

Outcomes in patients with "successful" recanalization in anterior circulation stroke treated with mechanical thrombectomy: TICI 3 versus TICI 2b

ObjectiveTo investigate the difference in the outcomes in patients with acute anterior circulation stroke having achieved the Thrombolysis in Cerebral Infarction (TICI) 2b and TICI 3 recanalization after mechanical thrombectomy.MethodsThe patients with acute anterior circulation stroke having achieved "successful" recanalization after mechanical thrombectomy were enrolled retrospectively.They were divided into TICI 2b ("almost complete" recanalization) group and TICI 3 ("complete" recanalization) group.The good outcome was defined as the modified Rankin Scale score 0-2 at 3 months after onset.ResultsA total of 83 patients were enrolled in the study, including 38 patients (45.8%) with TICI 2b and 45 (54.2%) with TICI 3;49 (59.0%) had good outcome, and 34 (40.9%) had poor outcome.The good outcome rate in the TICI 3 group was significantly higher than that in the TICI 2b group (68.9% vs.47.4%;χ2=3.946, P=0.047).After adjusting for age, hypertension, diabetes, baseline systolic blood pressure, triglyceride, intravenous thrombolysis, and ASITN/SIR collateral grades, TICI 3 was an independent predictor for good outcome at 3 months after onset (odds ratio OR] 3.759, 95% confidence interval CI] 1.098-12.871;P=0.035), while the higher baseline National Institutes of Health Stroke Scale score (OR 0.820, 95% CI 0.715-0.941;P=0.005) and higher fasting glucose (OR 0.610, 95% CI 0.410-0.906;P=0.014) were the independent predictors for poor outcome at 3 months after onset.ConclusionsThere are difference in the outcomes in patients with "successful" recanalization in anterior circulation stroke treated with mechanical thrombectomy.The outcome is substantially better in TICI 3 than TICI 2b patients.