Department of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg. 2020 Sep;12(9):837-841. doi: 10.1136/neurintsurg-2020-016111. Epub 2020 Jun 2.
Variability in early neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is well documented. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation.
To determine the incidence of early and delayed functional independence and identify associated predictors after EVT.
A retrospective analysis of prospectively collected data on patients undergoing EVT in the setting of anterior circulation LVO was performed. Demographic, clinical, radiological, treatment, and procedural information were analyzed. Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0-2 at discharge) and delayed functional independence (DFI, mRS score 0-2 at 90 days in non-EFI patients) were analyzed.
Three hundred and fifty-five patients met the study criteria. 55% were women and mean age was 71±15. Mean National Institutes of Health Stroke Scale (NIHSS) score was 17±6 and median Alberta Stroke Program Early CT Score was 9 (8-10). EFI was observed in 21% (73) of patients. Among non-EFI patients (282), DFI was observed in 30% (85) of patients. Shorter time to treatment (p=0.03), lower 24 hours NIHSS score (p<0.001), and smaller follow-up infarct volume (p=0.003) were independent predictors of EFI. Younger age (p=0.011), lower 24 hours NIHSS score (p=0.001), and absence of parenchymal hemorrhage (PH2; p=0.039) were independent predictors of DFI.
Approximately one-fifth of patients experience EFI and one-third of non-early improvers experience DFI. Younger age, lower 24 hours NIHSS score, and absence of parenchymal hemorrhage were independent predictors of DFI among non-early improvers. Further studies are required to improve our understanding of DFI.
血管内血栓切除术（EVT）治疗大动脉闭塞（LVO）卒中后早期神经功能改善的变异性已有充分记录。了解 EVT 后功能独立性的时间进展，特别是在没有早期改善的患者中出现的延迟功能独立性，对于预后和康复至关重要。
确定 EVT 后早期和延迟功能独立性的发生率，并确定相关的预测因素。
对在大脑前循环 LVO 血管内治疗中前瞻性收集的数据进行回顾性分析。分析人口统计学、临床、影像学、治疗和手术信息。分析早期功能独立性（EFI，出院时改良 Rankin 量表（mRS）评分 0-2）和延迟功能独立性（DFI，非 EFI 患者 90 天时 mRS 评分 0-2）的发生率和预测因素。
355 例患者符合研究标准。55%为女性，平均年龄为 71±15 岁。平均国立卫生研究院卒中量表（NIHSS）评分为 17±6，中位数 Alberta 卒中项目早期 CT 评分 9（8-10）。21%（73）的患者出现 EFI。在非 EFI 患者（282 例）中，30%（85 例）的患者出现 DFI。治疗时间更短（p=0.03）、24 小时 NIHSS 评分更低（p<0.001）和随访梗死体积更小（p=0.003）是 EFI 的独立预测因素。年龄较小（p=0.011）、24 小时 NIHSS 评分较低（p=0.001）和无实质内出血（PH2；p=0.039）是非早期改善患者 DFI 的独立预测因素。
大约五分之一的患者出现 EFI，三分之一的非早期改善患者出现 DFI。在非早期改善患者中，年龄较小、24 小时 NIHSS 评分较低和无实质内出血是 DFI 的独立预测因素。需要进一步研究以提高对 DFI 的理解。
