2012国际卒中大会:卒中血管内治疗转归与ASPECTS相关
2012-02-17 MedSci MedSci原创
2012国际卒中大会公布的START研究初步结果显示,CTA原始图像所示的治疗前艾伯塔卒中方案早期CT评分(ASPECTS)较高与血管内治疗后转归较好相关。NCCT与ASPECTS对比研究为确定其转归预测相对准确性所必需。 目前尚无用于选择患者行血管内卒中治疗(EVT)的标准成像方法。CT依然是应用最为广泛的卒中评价方法,并且ASPECTS定量的非强化CT缺血改变(NCCT
2012国际卒中大会公布的START研究初步结果显示,CTA原始图像所示的治疗前艾伯塔卒中方案早期CT评分(ASPECTS)较高与血管内治疗后转归较好相关。NCCT与ASPECTS对比研究为确定其转归预测相对准确性所必需。
Methods: START was a prospective multicenter study to evaluate the clinical impact of pre-treatment core infarct size in patients undergoing EVT using the Penumbra System. The imaging approach was left to each center‟s discretion, and included NCCT, CTA-SI, CT perfusion or MRI diffusion imaging. This study focused on the preliminary CTA-SI results. ASPECTS was graded in a blinded fashion and analyzed according to the a priori classification scheme (0-4, 5-7, 8-10), as well as using the entire scale. Clinical outcomes were dichotomized as 90-day modified Rankin Scale scores (mRS) of 0-2 (good) vs. 3-6. Univariate and multivariate analyses were performed to determine predictors of outcome.
Results: Of the 145 patients enrolled, 56 met study criteria for this preliminary analysis. The mean age was 65.5 ± 14.2 years; median NIHSS was 19.5 (14-24). There were 30 (53.6%) females, and target vessel occlusions were in the ICA (n=14), MCA M1 & M2 segments (n=41). The median pre-ASPECTS on CTA-SI was 6 (4.5-7). There were 14 (25%) patients with scores of 0-4, 34 (60.7%) with 5-7, 8 (14.3%) with 8-10. The rate of TIMI 2-3 revascularization was 87.3% (48/55). The median time from groin puncture to discontinuation of aspiration was 73.5 (40-108) minutes. Twenty-seven (48.2%) patients achieved a good 90-day outcome. Fifteen (26.8%) died. Only one (1.8%) patient suffered a symptomatic hemorrhage. Higher pre-ASPECTS on CTA-SI was significantly associated with good outcomes (median 6 [IQR 5-7] vs. 5 [IQR 3-7], p<0.05). The rate of good outcomes (mRS 0-2) was 21.4% for ASPECTS 0-4, 55.9% for 5-7, and 62.5% for 8-10 (p=0.08). Adjusting for age and NIHSS, pre-ASPECTS was an independent predictor of good outcome (OR 1.5, p<0.04). In ROC analysis, ASPECTS >4 was the optimal threshold for identifying good outcomes (89% sensitivity, 38% specificity). Other univariate predictors of good outcome were lower age (p=0.02), lower NIHSS (p=0.02), more distal occlusion (p<0.05) and shorter time from groin puncture to stopping aspiration (p=0.02).
Conclusions: These preliminary results show that higher pre-treatment ASPECTS on CTA source images is associated with better outcomes following endovascular therapy. Comparative studies versus NCCT ASPECTS are necessary to determine their relative accuracy for outcome prediction.
作者:MedSci
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