Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain.
Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain.
J Neurointerv Surg. 2021 Feb;13(2):119-123. doi: 10.1136/neurintsurg-2020-015934. Epub 2020 May 27.
Single-center studies have suggested that the early clinical course after mechanical thrombectomy (MT) in patients with ischemic stroke is a clinical predictor of long-term outcome.
To analyze the prognostic value of clinical improvement within 24 hours in a population-based multicenter cohort.
From a total of 3792 patients with acute ischemic stroke in Catalonia (CICAT registry), 1951 patients were treated with MT. The National Institutes of Health Stroke Scale (NIHSS) score within 24 hours, and follow-up was available in 1666 patients. Percentage variation in the NIHSS score was calculated in relation to a baseline assessment. Good outcome was defined as a modified Rankin Scale score ≤2 at 90 days. Predictive values of clinical improvement and adjusted OR to predict good outcomes were assessed in the whole cohort and the subgroup of patients with posterior circulation stroke (n=166).
Good outcome was achieved in 656/1666 patients (39%) overall. Percentage improvements both at the end of MT and at 24 hours predicted good outcome, with higher predictive capacity at 24 hours (C-statistic, 0.85 vs 0.73, p<0.001). Positive and negative predictive values were 70% and 74% for the >30% cut-off point at the end of MT, and 69% and 84% for the >50% cut-off point at 24 hours, respectively. The adjusted OR for good outcome was 5.8 (95% CI 4.2 to 8.1) and 12.9 (95% CI 9.7 to 17.1), respectively. In patients with posterior circulation stroke, the predictive value of the improvement at 24 hours was similar (C-statistic 0.90).
Clinical improvement of patients within 24 hours of MT is a reliable and robust predictor of long-term prognosis, including patients with posterior circulation occlusions.
单中心研究表明，缺血性卒中患者接受机械取栓（MT）后的早期临床病程是长期预后的临床预测因素。
在基于人群的多中心队列中分析 24 小时内临床改善的预后价值。
在加泰罗尼亚（CICAT 登记处）的 3792 例急性缺血性卒中患者中，1951 例接受 MT 治疗。24 小时内 NIHSS 评分和 1666 例患者的随访结果可用。计算 NIHSS 评分相对于基线评估的百分比变化。90 天改良 Rankin 量表评分≤2 定义为良好结局。在整个队列和后循环卒中（n=166）亚组中评估临床改善的预测值和调整 OR 以预测良好结局。
1666 例患者中（39%）整体达到良好结局 656 例。MT 结束时和 24 小时的百分比改善均预测良好结局，24 小时时的预测能力更高（C 统计量，0.85 对 0.73，p<0.001）。MT 结束时>30%的截断点的阳性和阴性预测值分别为 70%和 74%，24 小时时>50%的截断点分别为 69%和 84%。良好结局的调整 OR 分别为 5.8（95%CI 4.2 至 8.1）和 12.9（95%CI 9.7 至 17.1）。在后循环卒中患者中，24 小时改善的预测价值相似（C 统计量 0.90）。
MT 后 24 小时内患者的临床改善是长期预后的可靠且强大的预测因素，包括后循环闭塞患者。
