Objective: To evaluate the safety and efficacy of endovascular thrombectomy (EVT) in acute anterior circulation large vessel occlusive stroke (ALVOS) and explore the related influencing factors for prognoses in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECT). Methods: Patients with acute ALVOS who underwent EVT in Yijishan Hospital of Wannan Medical College from January 2019 to June 2022 were sequentially enrolled. (1) Patients were divided into a low ASPECT group (0-5) and a non-low ASPECT group (6-10), and the differences between the two groups were compared with respect to incidence of perioperative complications and good prognosis rate [modified Rankin scale (mRS) score≤2] 90 days after onset. (2) According to the prognoses 90 days after onset, the low ASPECT group was divided into the good prognosis (mRS score≤2) and poor prognosis (mRS score>2) subgroup. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent risk factors for prognoses of the low ASPECT patients after EVT. Results: A total of 582 patients [age 26-94(69±11) years, 345 male patients (59.3%)] were enrolled for analysis. The baseline ASPECT score was 8 (7, 10), and the baseline NIHSS score was 14 (11, 18). Among them, 102 (17.5%) patients were in the low ASPECT score group and 480 (82.5%) patients were in the non-low ASPECT score group. In the total cohort, patients in the low ASPECT score group had a higher incidence of symptomatic intracranial hemorrhage, lower 90-day good prognosis rate, and higher 90-day mortality rate. Further, propensity score matching statistical analysis showed that patients in the low ASPECT score group had a significantly higher incidence of malignant brain edema after EVT treatment (40.0% vs. 17.6%, χ2=9.13, P=0.003), and a significantly lower 90-day good prognosis rate (24.7% vs. 41.6%, χ2=4.96, P=0.026), but there was no significant difference in the incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (40.3% vs. 26.0%, χ2=3.55, P=0.060). Among 102 patients with low ASPECT score, 22 (21.6%) patients had good prognosis and 80 (78.4%) had poor prognosis. Multivariate logistic regression analysis showed that history of atrial fibrillation (OR=4.478, 95%CI 1.186-16.913, P=0.027) was an independent risk factor for poor prognosis of EVT in patients with low ASPECT score, while good collateral circulation (grade 2 vs. grade 0: OR=0.206, 95%CI 0.051-0.842, P=0.028) was a protective factor for good prognosis of EVT in patients with low ASPECT score. Conclusions: Although the 90-day good prognosis rate of EVT treatment for patients with low ASPECT score was lower than that of the non-low ASPECT group, 21.6% patients still benefitted from EVT treatment, especially patients with non-atrial fibrillation and good collateral circulation. Future studies involving more patients are needed to validate our observations.
目的： 评估低基线Alberta卒中计划早期CT（ASPECT）评分急性大血管闭塞性卒中患者早期血管内治疗（EVT）的安全性及有效性，并探讨影响该类患者预后的相关因素。 方法： 回顾性收集皖南医学院第一附属医院（弋矶山医院）卒中中心2019年1月至2022年6月收治的行EVT治疗的前循环急性大血管闭塞性卒中患者582例纳入分析，年龄26~94（69±11）岁，男性患者345例（59.3%）。（1）根据基线ASPECT评分将患者分为低评分组（0~5分）与非低评分组（6~10分），比较2组间围手术期并发症发生率、90 d预后良好率［改良Rankin量表（mRS）评分≤2分］及病死率的差异。（2）根据90 d预后情况将低评分组患者分为预后良好亚组（mRS评分≤2分）与预后不良亚组（mRS评分>2分），采用单因素分析及多因素logistic回归分析探讨影响低ASPECT评分患者EVT治疗预后的独立危险因素。 结果： 基线ASPECT评分为8（7，10）分，基线美国国立卫生研究院卒中量表（NIHSS）评分为14（11，18）分；其中低ASPECT评分组患者102例（17.5%），非低ASPECT评分组患者480例（82.5%）。总体人群中，低ASPECT评分组患者中症状性颅内出血发生率更高、90 d良好预后率更低、90 d病死率更高，进一步对两组患者的基线资料进行倾向性评分匹配（1∶1）后统计分析显示，低ASPECT评分组患者经EVT治疗后恶性脑水肿发生率明显高于非低ASPECT评分组（40.0% 比 17.6%，χ2=9.13，P=0.003）、90 d预后良好率明显低于非低ASPECT评分组（24.7% 比 41.6%，χ2=4.96，P=0.026），差异有统计学意义，但2组患者间症状性颅内出血发生率（11.8% 比 9.2%，χ2=0.28，P=0.597）、90 d病死率（40.3% 比 26.0%，χ2=3.55，P=0.060）差异均无统计学意义。102例低ASPECT评分组患者中，预后良好患者22例（21.6%），预后不良患者80例（78.4%）。多因素logistic回归分析显示，既往心房颤动病史（OR=4.478，95%CI 1.186~16.913，P=0.027）是低ASPECT评分组患者EVT治疗预后不良的独立危险因素，而良好的侧支循环（2级比0级：OR=0.206，95%CI 0.051~0.842，P=0.028）是低ASPECT评分组患者EVT治疗预后良好的保护因素。 结论： 低ASPECT评分患者行EVT治疗尽管90 d良好预后率低于非低评分组，但仍有21.6%的患者获益，尤其是对具有良好侧支循环的非房颤患者，结论仍需进一步循证医学证据证实。.