Lee Sang-Hwa, Kim Beom Joon, Han Moon-Ku, Park Tai Hwan, Lee Kyung Bok, Lee Byung-Chul, Yu Kyung-Ho, Oh Mi Sun, Cha Jae Kwan, Kim Dae-Hyun, Nah Hyun-Wook, Lee Jun, Lee Soo Joo, Kim Jae Guk, Park Jong-Moo, Kang Kyusik, Cho Yong-Jin, Hong Keun-Sik, Park Hong-Kyun, Choi Jay Chol, Kim Joon-Tae, Choi Kangho, Kim Dong-Eog, Ryu Wi-Sun, Kim Wook-Joo, Shin Dong-Ick, Yeo Minju, Sohn Sung-Il, Hong Jeong-Ho, Lee Juneyoung, Lee Ji Sung, Khatri Pooja, Bae Hee-Joon
Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
BMC Neurol. 2019 Jan 15;19(1):11. doi: 10.1186/s12883-019-1237-2.
Futile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT.
Using a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b-3). The rate of futile reperfusion was assessed across the initial National Institutes of Health Stroke Scale (NIHSS) scores. The frequency of poor outcomes (modified Rankin scale [mRS] 3-6) according to NIHSS scores was compared between patients revascularized successfully by EVT and those who did not receive EVT, after standardizing for age.
Among 21,591 patients with ischemic stroke, 972 (4.5%) received EVT within 12 h of onset, including 440 who met study eligibility criteria. Futile reperfusion was observed in 226 of the 440 study-eligible patients (51.4%) and was associated with stroke severity: 20.9% in NIHSS scores ≤5, 34.6% in 6-10, 58.9% in 11-20, and 63.8% in > 20 (p < 0.001). Nonetheless, the therapeutic benefit of EVT also increased with increasing stroke severity (p for interaction < 0.001): 0.1% in NIHSS ≤5, 18.6% in 6-10, 28.7% in 11-20, and 34.3% in > 20.
EVT is more beneficial with increasing stroke severity, although futile reperfusion also increases with higher stroke severity.
在近期的血管内治疗（EVT）临床试验中，高达67%的入组患者出现了无效再灌注（尽管成功再灌注但功能状态仍较差）。我们研究了基线卒中严重程度对无效再灌注和成功EVT治疗效果的影响。
利用前瞻性多中心卒中登记系统，我们识别出连续的前循环大动脉闭塞性缺血性卒中患者，这些患者通过EVT成功实现再灌注（脑梗死溶栓分级2b - 3级）。根据初始美国国立卫生研究院卒中量表（NIHSS）评分评估无效再灌注率。在对年龄进行标准化后，比较了通过EVT成功实现血管再通的患者与未接受EVT的患者中，根据NIHSS评分得出的不良结局（改良Rankin量表[mRS] 3 - 6分）的发生频率。
在21,591例缺血性卒中患者中，972例（4.5%）在发病12小时内接受了EVT，其中440例符合研究纳入标准。在440例符合研究标准的患者中，有226例（51.4%）出现无效再灌注，且与卒中严重程度相关：NIHSS评分≤5分时为20.9%，6 - 10分时为34.6%，11 - 20分时为58.9%，>20分时为63.8%（p < 0.001）。尽管如此，EVT的治疗效果也随着卒中严重程度的增加而提高（交互作用p < 0.001）：NIHSS≤5分时为0.1%，6 - 10分时为18.6%，11 - 20分时为28.7%，>20分时为34.3%。
尽管无效再灌注也随着卒中严重程度的增加而增加，但EVT在卒中严重程度越高时越有益。
