From the Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (T.S., Y.Y.).
Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan (R.I.).
Stroke. 2020 May;51(5):1458-1463. doi: 10.1161/STROKEAHA.119.028562. Epub 2020 Apr 16.
Background and Purpose- The treatment and prognosis of acute large vessel occlusion with mild symptoms have not been sufficiently studied. The present study aimed to investigate the clinical or radiological predictors of clinical outcome in patients with stroke with mild symptoms due to acute large vessel occlusion. Methods- Of 2420 patients with acute large vessel occlusion in the RESCUE-Japan Registry 2 (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Registry 2), a multicenter prospective registry in Japan, patients with modified Rankin Scale scores of 0 to 2 before onset and initial National Institutes of Health Stroke Scale (NIHSS) scores of 0 to 5 were examined in post hoc analysis. We examined the clinical and radiological characteristics associated with a favorable outcome (modified Rankin Scale score, 0-2 at 90 days) using multivariate analysis, as well as the factors associated with a favorable outcome in patients treated with endovascular therapy. Results- We analyzed 272 patients (median age, 73 years; median NIHSS score on admission, 3). Eighty-six (31.6%) patients were treated with intravenous recombinant tissue-type plasminogen activator, 54 (19.9%) underwent endovascular therapy, and 208 (76.5%) showed a favorable outcome. In multivariate analysis, age <75 years (odds ratio [OR], 2.42 [95% CI, 1.30-4.50]), initial NIHSS score 0 to 3 (OR, 3.08 [95% CI, 1.59-5.98]), intravenous recombinant tissue-type plasminogen activator (OR, 2. 86 [95% CI, 1.32-6.21]), and blood glucose level ≤140 mg/dL (OR, 2.37 [95% CI, 1.22-4.60]) were independently associated with a favorable outcome. However, endovascular therapy was not associated with a favorable outcome (OR, 1.65 [95% CI, 0.71-3.88]). Among 54 patients treated with endovascular therapy, good reperfusion status was more common in the favorable outcome group (88.6% versus 60.0%; <0.05). Conclusions- Younger age, lower initial NIHSS score, intravenous recombinant tissue-type plasminogen activator, and absence of hyperglycemia were independently associated with a favorable outcome in patients with acute large vessel occlusion with low NIHSS scores. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.
背景与目的- 对于轻度症状的急性大血管闭塞患者，其治疗和预后尚未得到充分研究。本研究旨在探讨急性大血管闭塞导致的轻度症状性卒中患者的临床或影像学预测因素。
方法- 在日本多中心前瞻性登记研究 RESCUE-Japan 登记研究 2 中，对 2420 例急性大血管闭塞患者（RESCUE-Japan 登记研究 2 中因急性大血管闭塞而导致的卒中患者的改良 Rankin 量表评分在发病前为 0 至 2 分，且初始 NIHSS 评分在 0 至 5 分）进行了事后分析。我们使用多变量分析检查了与良好结局（改良 Rankin 量表评分在 90 天时为 0-2 分）相关的临床和影像学特征，以及与血管内治疗患者良好结局相关的因素。
结果- 我们分析了 272 例患者（中位年龄为 73 岁；入院时中位 NIHSS 评分为 3）。86 例（31.6%）患者接受了静脉重组组织型纤溶酶原激活剂治疗，54 例（19.9%）接受了血管内治疗，208 例（76.5%）取得了良好的结局。多变量分析显示，年龄<75 岁（优势比 [OR]，2.42[95%CI，1.30-4.50]）、初始 NIHSS 评分 0-3（OR，3.08[95%CI，1.59-5.98]）、静脉重组组织型纤溶酶原激活剂（OR，2.86[95%CI，1.32-6.21]）和血糖水平≤140mg/dL（OR，2.37[95%CI，1.22-4.60]）与良好结局独立相关。然而，血管内治疗与良好结局无关（OR，1.65[95%CI，0.71-3.88]）。在 54 例接受血管内治疗的患者中，良好的再灌注状态在结局良好的组中更为常见（88.6%比 60.0%；<0.05）。
结论- 在 NIHSS 评分较低的急性大血管闭塞患者中，年龄较小、初始 NIHSS 评分较低、静脉重组组织型纤溶酶原激活剂和无高血糖与良好结局独立相关。
