From the Department of Neurology (R.-J.B.G., R.J.v.O.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands.
Department Neurology (M.V., J.B., I.v.d.W.), Haaglanden Medical Center, The Hague, the Netherlands.
Stroke. 2018 Oct;49(10):2406-2414. doi: 10.1161/STROKEAHA.118.022352.
Background and Purpose- Prestroke dependence is an exclusion criterion in most trials of endovascular treatment (EVT) for acute ischemic stroke. Little is known about outcomes after EVT in these patients. We compared outcome and safety of EVT between prestroke-dependent and prestroke-independent patients. Methods- We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke)-a prospective, multicenter, observational study for stroke intervention centers in the Netherlands. Prestroke dependence was defined as modified Rankin Scale score of 3 to 5 before onset of current stroke. Primary outcome was favorable outcome at 90 days, defined as modified Rankin Scale of 0 to 2 or not worsening of the modified Rankin Scale score. Secondary outcomes included National Institutes of Health Stroke Scale score post-intervention, reperfusion grade, and safety outcomes. Logistic regression analyses (adjusted for age, baseline National Institutes of Health Stroke Scale score, collaterals, time to EVT, and intravenous thrombolysis before EVT) were used to assess the association between prestroke dependence and outcomes. Results- One thousand four hundred forty-one patients were included in the present study, of whom 157 (11%) were prestroke dependent. Favorable outcome was seen in 27% prestroke-dependent patients, compared with 42% prestroke-independent patients ( P<0.05). After adjustment, prestroke dependence was not associated with less-favorable outcome (OR, 0.90; 95% CI, 0.58-1.39). The occurrence of symptomatic intracranial hemorrhage and ischemic stroke progression was similar in both groups. Conclusions- A substantial proportion of prestroke-dependent patients will reach prestroke modified Rankin Scale scores after EVT, and complication rates are comparable with prestroke-independent patients. Therefore, prestroke-dependent patients should not be routinely excluded from EVT.
背景与目的-在大多数急性缺血性脑卒中血管内治疗（EVT）的临床试验中，卒中前依赖是排除标准。对于这些患者，EVT 后的结局知之甚少。我们比较了卒中前依赖和卒中前非依赖患者接受 EVT 的结局和安全性。方法-我们报告了 2014 年 3 月至 2016 年 6 月在 MR CLEAN 登记研究（急性缺血性脑卒中血管内治疗的多中心随机临床试验）中纳入的前循环闭塞患者，该研究是荷兰卒中干预中心的一项前瞻性、多中心、观察性研究。卒中前依赖定义为当前卒中发作前改良 Rankin 量表（mRS）评分为 3-5 分。主要结局为 90 天的良好结局，定义为 mRS 评分 0-2 分或 mRS 评分无恶化。次要结局包括介入后 NIHSS 评分、再灌注分级和安全性结局。使用逻辑回归分析（调整年龄、基线 NIHSS 评分、侧支循环、EVT 时间和 EVT 前静脉溶栓）评估卒中前依赖与结局之间的关系。结果-本研究共纳入 1441 例患者，其中 157 例（11%）为卒中前依赖。卒中前依赖患者的良好结局率为 27%，而卒中前非依赖患者为 42%（P<0.05）。调整后，卒中前依赖与结局不佳无关（OR，0.90；95%CI，0.58-1.39）。两组症状性颅内出血和缺血性卒中进展的发生率相似。结论-相当一部分卒中前依赖患者在 EVT 后将达到卒中前 mRS 评分，且并发症发生率与卒中前非依赖患者相当。因此，不应常规将卒中前依赖患者排除在 EVT 之外。
