Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Int J Stroke. 2019 Dec;14(9):887-892. doi: 10.1177/1747493019841244. Epub 2019 Apr 4.
Many patients with large vessel occlusion (LVO) who are otherwise candidates for endovascular treatment (EVT) have had previous strokes. We aimed to examine the effect of previous stroke on outcome after EVT.
Consecutive patients with LVO were prospectively entered into a National Acute Stroke registry of patients undergoing EVT. Patients treated with EVT were divided into those with and without previous strokes. The rates of favorable reperfusion status, mortality, and excellent outcome at 90 days post-stroke as well as symptomatic intracranial hemorrhage (sICH) were evaluated.
A total of 390 underwent EVT and 35 had previous strokes. Patients with previous strokes were significantly older; more frequently had a history of prior myocardial infarction and more often had pre-existing functional disability. Favorable target vessel recanalization was less frequently achieved in patients with previous strokes (60% vs. 82%; = 0.005) and ordinal regression analysis for functional outcome revealed higher frequency of deterioration at three months in patients with previous strokes. Nevertheless, 9% of these patients maintained their previous disability state and sICH rates did not differ between the groups. Mortality rates at one year post stroke were significantly higher in patients with previous strokes (37% vs. 16%; = 0.005).
Previous strokes are associated with higher likelihoods of mortality and unfavorable outcome in patients with LVO undergoing EVT. However, because some of these patients maintain their previous disability state, the presence of previous stroke should not be used as an exclusion criterion from EVT.
许多适合血管内治疗（EVT）的大血管闭塞（LVO）患者既往有过卒中。本研究旨在评估既往卒中对 EVT 后结局的影响。
连续纳入接受 EVT 的大血管闭塞患者进入国家急性卒中登记研究。将接受 EVT 治疗的患者分为有既往卒中史和无既往卒中史。评估两组患者再通状态良好率、死亡率和卒中后 90 天的良好预后以及症状性颅内出血（sICH）的发生率。
共 390 例患者接受 EVT，其中 35 例有既往卒中史。既往卒中组患者年龄较大，既往心肌梗死史和预先存在的功能残疾更为常见。既往卒中组患者的靶血管再通情况较差（60% vs. 82%； = 0.005），且对功能结局的有序回归分析显示既往卒中组患者在 3 个月时功能恶化的频率更高。然而，这些患者中有 9%的人保持了先前的残疾状态，且两组的 sICH 发生率无差异。卒中后 1 年的死亡率在既往卒中组显著更高（37% vs. 16%； = 0.005）。
既往卒中与 LVO 患者接受 EVT 后更高的死亡率和不良结局相关。然而，由于这些患者中的一些人保持了先前的残疾状态，因此既往卒中不应该作为 EVT 的排除标准。
