Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Athens, Greece.
J Neurointerv Surg. 2020 Feb;12(2):142-147. doi: 10.1136/neurintsurg-2019-014935. Epub 2019 Jun 26.
One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).
To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.
Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.
A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11-20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).
IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.
机械血栓切除术（MT）的一种罕见并发症是新的先前未受影响的区域出现梗死（新梗死区（INT））。
评估 INT 的预测因素，特别关注 MT 前的静脉溶栓（IVT）预处理。
评估了在 5 年期间接受 MT 治疗的连续出现的大血管闭塞（ELVO）患者。使用 ESCAPE 研究者提出的标准化方法定义 INT。研究了 INT 的预测因素及其对结果的影响。
共有 419 例连续出现 ELVO 的患者接受了 MT 治疗（平均年龄 64±15 岁，50%为男性，中位数基线国立卫生研究院卒中量表评分 16 分（IQR 11-20），69%接受 IVT 预处理）。与单独接受 MT 治疗的患者相比，接受联合治疗（IVT 和 MT）的患者发生 INT 的发生率较低，分别为 10%和 20%（p=0.011）。INT 组的后循环闭塞患者多于无 INT 组（分别为 28%和 10%，p<0.001）。INT 组的 3 个月功能独立性率较低（30%和 50%，p=0.007）。IVT 预处理与 INT 无独立相关性（OR=0.75；95%CI 0.32 至 1.76），INT 也未成为 3 个月功能独立性的独立预测因素（OR=0.69；95%CI 0.29 至 1.62）多变量逻辑回归模型。后循环闭塞的位置与更高的 INT 几率独立相关（OR=3.33；95%CI 1.43 至 7.69；p=0.005）。
IVT 预处理与 MT 治疗的 ELVO 患者 INT 发生率较低无独立相关性。接受 MT 治疗的 ELVO 伴后循环闭塞的患者更有可能发生 INT。
