Rahme Ralph, Yeatts Sharon D, Abruzzo Todd A, Jimenez Lincoln, Fan Liqiong, Tomsick Thomas A, Ringer Andrew J, Furlan Anthony J, Broderick Joseph P, Khatri Pooja
Departments of Neurosurgery.
J Neurosurg. 2014 Dec;121(6):1354-8. doi: 10.3171/2014.7.JNS131430. Epub 2014 Sep 26.
The role of endovascular therapy in patients with acute ischemic stroke and a solitary M2 occlusion remains unclear. Through a pooled analysis of 3 interventional stroke trials, the authors sought to analyze the impact of successful early reperfusion of M2 occlusions on patient outcome.
Patients with a solitary M2 occlusion were identified from the Prolyse in Acute Cerebral Thromboembolism (PROACT) II, Interventional Management of Stroke (IMS), and IMS II trial databases and were divided into 2 groups: successful reperfusion (thrombolysis in cerebral infarction [TICI] 2-3) at 2 hours and failed reperfusion (TICI 0-1) at 2 hours. Baseline characteristics and clinical outcomes were compared.
Sixty-three patients, 40 from PROACT II and 23 from IMS and IMS II, were identified. Successful early angiographic reperfusion (TICI 2-3) was observed in 31 patients (49.2%). No statistically significant difference in the rates of intracerebral hemorrhage (60.9% vs 47.6%, p = 0.55) or mortality (19.4% vs 15.6%, p = 0.75) was observed. However, there was a trend toward higher incidence of symptomatic hemorrhage in the TICI 2-3 group (17.4% vs 0%, p = 0.11). There was also a trend toward higher baseline glucose levels in this group (151.5 mg/dl vs 129.6 mg/ dl, p = 0.09). Despite these differences, the rate of functional independence (modified Rankin Scale Score 0-2) at 3 months was similar (TICI 2-3, 58.1% vs TICI 0-1, 53.1%; p = 0.80).
A positive correlation between successful early reperfusion and clinical outcome could not be demonstrated for patients with M2 occlusion. Irrespective of reperfusion status, such patients have better outcomes than those with more proximal occlusions, with more than 50% achieving functional independence at 3 months.
血管内治疗在急性缺血性卒中合并孤立性M2闭塞患者中的作用尚不清楚。通过对3项介入性卒中试验的汇总分析，作者试图分析M2闭塞成功早期再灌注对患者预后的影响。
从急性脑栓塞的普洛赛克（PROACT）II、卒中介入管理（IMS）和IMS II试验数据库中识别出孤立性M2闭塞的患者，并分为两组：2小时时成功再灌注（脑梗死溶栓 [TICI] 2-3级）和2小时时再灌注失败（TICI 0-1级）。比较基线特征和临床结局。
共识别出63例患者，其中40例来自PROACT II，23例来自IMS和IMS II。31例患者（49.2%）观察到早期血管造影成功再灌注（TICI 2-3级）。脑出血发生率（60.9% 对47.6%，p = 0.55）或死亡率（19.4% 对15.6%，p = 0.75）无统计学显著差异。然而，TICI 2-3组有症状性出血发生率更高的趋势（17.4% 对0%，p = 0.11）。该组基线血糖水平也有更高的趋势（151.5 mg/dl对129.6 mg/dl，p = 0.09）。尽管存在这些差异，但3个月时功能独立率（改良Rankin量表评分0-2）相似（TICI 2-3组为58.1%，TICI 0-1组为53.1%；p = 0.80）。
对于M2闭塞患者，未能证明早期成功再灌注与临床结局之间存在正相关。无论再灌注状态如何，此类患者的预后均优于近端闭塞患者，超过50%的患者在3个月时实现功能独立。
