Department of Neurology, University Hospital Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
Department of Neuroradiology, Medical Center, University Hospital Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
J Neurol. 2020 Apr;267(4):1026-1034. doi: 10.1007/s00415-019-09670-w. Epub 2019 Dec 13.
Mechanical thrombectomy (MT) improves early clinical outcome in patients with acute ischemic stroke but insights on determinants of long-term outcome after MT treatment are scarce.
Data from stroke patients with anterior circulation large vessel occlusion of a prospective MT registry (01/2014-06/2017) of a large comprehensive stroke center were analyzed regarding clinical outcome between short- (3 months) and long-term (12 months) assessment reflected by a change of modified Rankin scores (∆mRS). Secondary endpoints included favorable long-term outcome (mRS 0-2). Multi-variable regression analysis was performed to identify determinants of outcome changes and favorable outcome at long term.
Of 264 patients included, 42.0% showed a favorable long-term outcome. Longitudinal analysis found that some individuals still improved, but no overall mRS difference between short and long-term follow-up was detected [∆mRS - 0.004 (95% CI - 0.020; 0.013); p = 0.672]. Right hemispheric stroke [∆mRS 0.286 (0.011; 0.561); p = 0.043] and high NIHSS at discharge [∆mRS, 0.039 (0.004; 0.074); p = 0.029] were associated with a longitudinal mRS decline. Favorable long-term outcome was associated with successful recanalization (p < 0.0001).
A significant number of patients with MT experience a favorable long-term outcome. Outcomes remained stable between short- and long-term follow-up, but some individuals may still show improvement beyond short-term rehabilitation. Right hemispheric stroke and clinical stroke severity at hospital discharge may be frail predictors for delayed decline of functional status, whereas successful recanalization remains a positive outcome predictor. Death rarely occurs beyond 3 months after MT treatment.
机械取栓（MT）可改善急性缺血性脑卒中患者的早期临床结局，但关于 MT 治疗后长期结局的决定因素的了解甚少。
对一家大型综合卒中中心前瞻性 MT 登记处（2014 年 1 月至 2017 年 6 月）中急性前循环大血管闭塞的卒中患者的数据进行分析，评估 3 个月和 12 个月时改良 Rankin 评分（mRS）变化所反映的短期和长期（12 个月）临床结局。次要终点包括长期预后良好（mRS 0-2）。采用多变量回归分析确定结局变化和长期预后良好的决定因素。
共纳入 264 例患者，42.0%的患者预后良好。纵向分析发现，一些患者仍在改善，但短时间和长时间随访之间的 mRS 总体差异没有检测到[ mRS 差值为-0.004（95%CI-0.020；0.013）；p=0.672]。右侧半球卒中[ mRS 差值为 0.286（0.011；0.561）；p=0.043]和出院时 NIHSS 较高[ mRS 差值，0.039（0.004；0.074）；p=0.029]与 mRS 纵向下降相关。长期预后良好与再通成功相关（p<0.0001）。
接受 MT 治疗的患者中有相当一部分预后良好。短期和长期随访之间的结局保持稳定，但一些患者可能在短期康复后仍有改善。右侧半球卒中和出院时的临床卒中严重程度可能是功能状态延迟下降的脆弱预测因素，而再通成功仍然是一个积极的结局预测因素。MT 治疗后 3 个月后很少发生死亡。
