University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
J Neurol. 2019 Mar;266(3):598-608. doi: 10.1007/s00415-018-09172-1. Epub 2019 Jan 8.
If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8.
Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0-1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 (N = 1423).
Among patients with NIHSS < 8 (N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0-1 (aOR 3.217, 95%-CI 1.174-8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050-0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8.
Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening.
对于出现大血管闭塞（LVO）且症状较轻的患者，是否应采用血管内治疗（EVT）仍不清楚。本研究的目的是：（1）评估 NIHSS<8 的患者接受 EVT 的安全性和技术疗效，与 NIHSS≥8 的患者进行比较；（2）评估 NIHSS<8 的患者再灌注的临床效果。
对回顾性多中心 BEYOND-SWIFT 登记研究（NCT03496064）中的患者进行分析。采用多变量逻辑回归分析（显示校正后的优势比[aOR]及 95%置信区间[95%-CI]）评估 NIHSS<8 的患者（N=193）达到成功再灌注（定义为改良脑梗死溶栓分级 2b/3）的临床效果。主要结局为 90 天的良好功能结局（改良Rankin 量表[mRS]0-1）。比较 NIHSS<8 的患者（N=193，77/193，77%接受血管内治疗前 IV-tPA）与 NIHSS≥8 的患者（N=1423）的机械血栓切除术的安全性和疗效。
在 NIHSS<8 的患者中，成功再灌注与 mRS 0-1 显著相关（aOR 3.217，95%-CI 1.174-8.816），并降低了非出血性神经恶化的几率（aOR 0.194，95%-CI 0.050-0.756），在调整了预设混杂因素后。在交互分析中，NIHSS<8 和 NIHSS≥8 的患者达到成功再灌注的相对益处基本相似，这表明 aOR 无显著差异。NIHSS<8 和 NIHSS≥8 的患者的介入安全性和疗效指标相似。
对于持续存在 LVO 且 NIHSS<8 的患者，达到成功再灌注是有益的，可以降低非出血性神经恶化的风险。
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