[Influencing factors of futile recanalization after endovascular therapy in acute ischemic stroke patients with large vessel occlusions].

Objective: To analyze the influencing factors of futile recanalization after endovascular therapy (EVT) in acute ischemic stroke patients with large vessel occlusions (AIS-LVO). Methods: AIS-LVO patients who underwent EVT with successful recanalization between January 2019 and December 2021 in Neurovascular Center of Changhai Hospital of Naval Medical University were retrospectively selected. Modified Rankin scale (mRS) score 3 months after EVT was used as the prognostic evaluation index, and patients with mRS scores≤2 were classified as the meaningful recanalization group and mRS scores 3-6 as the futile recanalization group. The risk factors, National Institutes of Health stroke scale (NIHSS) score, Glasgow coma scale (GCS) score, Alberta Stroke Program Early CT (ASPECT) score, core infarct volume, etc. in both groups were analyzed, and the influencing factors of futile recanalization after EVT were analyzed by multivariate logistic regression. Continuous variables that do not conform to the normal distribution are represented by [M(Q1,Q3)]. Results: A total of 368 patients meeting the inclusion criteria were collected, including 228 males and 140 females, and aged 68 (61, 77) years. There are 196 patients and 172 patients in the meaningful recanalization and futile recanalization groups, respectively, with the rate of futile recanalization 3 months after EVT of 46.74% (172/368). Comparing the general information and risk factors between the two groups found that the age of patients in the futile recanalization group [71 (65, 79) years] was higher than that in the meaningful recanalization group [65 (59, 72) years]. The baseline NIHSS score [18 (14, 22)] and the rate of not achieving modified Thrombolysis in Cerebral Ischemia grade 3 (mTICI 3) reperfusion (36.1%) were higher in the futile recanalization group than those in the meaningful recanalization group [12 (7, 17) and 19.9%]. The baseline GCS score [11 (9, 13)] was lower in the futile recanalization group than that in the meaningful recanalization group [14 (11, 15)]. The core infarct volume in the futile recanalization group [28 (7, 65) ml] was larger than that in the meaningful recanalization group [6 (0, 17) ml]. The ASPECT score [7 (5, 9)] was lower in the futile recanalization group than that in the meaningful recanalization group [9 (7, 10)]. In addition, the proportion of hypertension, atrial fibrillation, general anesthesia, and symptomatic intracranial hemorrhage was higher in the futile recanalization group (all P<0.05). The time from symptom onset to puncture and from symptom onset to reperfusion was longer in the futile recanalization group (both P<0.05). There were statistically significant differences in trial of Org 10172 in acute stroke treatment (TOAST) classification and the site of occluded blood vessels between the two groups (both P<0.05). Multivariate logistic regression indicated that age ≥80 years(OR=1.935,95%CI: 1.168-3.205), baseline NIHSS score (OR=1.999,95%CI: 1.202-3.325), GCS score (OR=2.299,95%CI: 1.386-3.814), previous stroke history (OR=1.977,95%CI: 1.085-3.604), general anesthesia (OR=1.981,95%CI: 1.143-3.435), not achieving grade 3 recanalization (OR=2.846, 95%CI: 1.575-5.143), ASPECT score<6 (OR=2.616, 95%CI: 1.168-5.857), and core infarct volume>70 ml (OR=2.712, 95%CI: 1.130-6.505) were risk factors for futile recanalization. Conclusion: Age≥80 years, previous stroke history, baseline NIHSS score≥20, GCS score≤8, general anesthesia, ASPECT score<6, core infarct volume>70 ml, and failure to achieve Grade 3 recanalization are independent influencing factors for futile recanalization after endovascular therapy in AIS-LVO patients.目的： 分析急性大血管闭塞性缺血性卒中（AIS-LVO）血管内治疗无效再通的影响因素。 方法： 回顾性选择2019年1月至2021年12月在海军军医大学第一附属医院脑血管病中心接受血管内治疗且成功再通的前循环AIS-LVO患者，以治疗后3个月改良 Rankin 量表（mRS）评分作为预后评价指标，mRS评分≤2分的患者为有效再通组，3~6 分为无效再通组。分析两组患者的危险因素、基线美国国立卫生研究院卒中量表（NIHSS）评分、基线格拉斯哥昏迷量表（GCS）评分、Alberta卒中项目早期CT评分（ASPECT）、核心梗死体积等指标，采用多因素 logistic 回归模型分析血管内治疗无效再通的影响因素。不符合正态分布的连续变量以［M（Q1，Q3）］表示。 结果： 符合入组标准的患者368例，男228例，女140例，年龄为68（61，77）岁。有效再通的患者196例，无效再通的患者172例，血管内治疗后3个月无效再通率为46.74%（172/368）。比较两组患者的一般资料和危险因素发现，无效再通组患者年龄［71（65，79）岁］大于有效再通组［65（59，72）岁］、基线NIHSS评分［18（14，22）分］和未达mtTICI分级3级再通率（36.1%）高于有效再通组［12（7，17）分、（19.9%）］，基线GCS评分［11（9，13）分］低于有效再通组［14（11，15）分］；比较两组患者影像学资料发现，无效再通组核心梗死体积［28（7，65）ml］大于有效再通组［6（0，17）分］，ASPECTS［7（5，9）分］低于有效再通组［9（7，10）分］。除此以外，无效再通组高血压病、房颤、全身麻醉和症状性颅内出血比例更高，发病到穿刺时间与发病到再通时间更长（均P<0.05）。两组患者在急性卒中Org10172治疗试验（TOAST）分型和闭塞血管部位差异均有统计学意义（均P<0.05）。多因素logistic回归模型分析结果显示，年龄≥80岁（OR=1.935，95%CI：1.168~3.205），基线NIHSS评分≥20分（OR=1.999，95%CI：1.202~3.325），GCS评分（OR=2.299，95%CI：1.386~3.814），既往有卒中史（OR=1.977，95%CI：1.085~3.604），全身麻醉（OR=1.981，95%CI：1.143~3.435），未达3级再通（OR=2.846，95%CI：1.575~5.143），ASPECTS<6分（OR=2.616，95%CI：1.168~5.857），核心梗死体积>70 ml（OR=2.712，95%CI：1.130~6.505）是无效再通的影响因素。 结论： 年龄≥80岁、既往卒中史、基线NIHSS评分≥20分、GCS评分≤8分、全身麻醉、ASPECTS<6分、核心梗死体积>70 ml、未达到3级再通是影响AIS-LVO患者血管内治疗后发生无效再通的影响因素。.