基于ASPECT评分预测取栓前予以静脉溶栓的获益
目的:
基线变量可用于指导机械取栓(MT)前予以静脉注射阿替普酶(IVT)。本研究的目的是确定基线成像和人口统计学参数如何改变IVT对大血管闭塞引起的缺血性卒中患者临床结局的影响。
方法:
对直接进入符合MT条件的中心后经多模态CT分诊接受MT治疗的缺血性卒中患者进行多中心回顾性队列研究。
采用反概率加权分析法(IPW)评估经基线变量调整后的IVT治疗效果。采用IPE加权和交互项对IVT进行多变量逻辑回归分析，以预测功能独立性(90天mRS 0-2)。
结果:
纳入720例患者，其中366例(51%)接受IVT。在IPW中，IVT对预后的治疗效果(mRS 0-2)根据ASPECTS亚组(ASPECTS 9-10:+15%，ASPECTS 6-8:+7%，
ASPECTS< 6:-11%)。在多变量逻辑回归分析中，IVT与功能独立性独立相关(aOR:
1.57,95%Cl:1.16-2.14,p=0.003)，交互项对ASPECTS和IVT具有显著性，表明IVT只与ASPECTS较高的患者的更好的预后显著相关。没有其他显著的基线变量交互项被确定。
总结:
ASPECTS是唯一显示与IVT在预后预测方面有显著交互作用的基线变量。在ASPECTS <6的患者中应用IVT可能会对预后产生不利影响，需要仔细考虑。
Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS.
PURPOSE: Baseline variables could be used to guide the administration of additional intravenous alteplase (IVT) before mechanical thrombectomy(MT). The aim of this study was to determine how baseline imaging and demographic parameters modify the effect of IVT on clinical outcomes in patients with ischemic stroke due to large vessel occlusion.
METHODS: Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT treatment after direct admission to an MT-eligible center.
Inverse-probability weighting analysis (IPW)was used to assess the treatment effect of IVT adjusted for baseline variables. Multivariable logistic regression analysis with IPW-weighting and interaction terms for IVT was performed to predict functional independence (mRS 0-2 at 90-days).
RESULTS: 720 patients were included, of which366 (51%) received IVT. In IPW, the treatment effect of IVT on outcome (mRS 0-2) distinctively varied according to the ASPECTS subgroup(ASPECTS 9-10:+15%,ASPECTS 6-8:+7%,
ASPECTS <6:-11%). In multivariable logistic regression analysis, IVT was independently associated with functional independence (aOR:
1.57,95%Cl:1.16-2.14,p=0.003)and the interaction term was significant for ASPECTS and IVT revealing that IVT was only significantly associated with better outcomes in patients with higher ASPECTS.No other significant baseline variable interaction terms were identified.
INTERPRETATION: ASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. The application of IVT in patients with an ASPECTS of <6 might have detrimental effects on outcome and may only be considered carefully. This article is protected by copyright. All rights reserved.
Annals of Neurology 2022 Jul 8;
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