Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan.
Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Japan.
World Neurosurg. 2020 Oct;142:e271-e277. doi: 10.1016/j.wneu.2020.06.209. Epub 2020 Jul 1.
Mechanical thrombectomy (MT) is the recommended treatment for patients with acute ischemic stroke due to large cerebral vessel occlusion (LVO). However, few studies have investigated long-term outcomes after MT. The aim of this study was to investigate functional outcomes at long-term follow-up (1 year after MT) in patients undergoing MT for anterior circulation LVO in real-world clinical practice.
This was a retrospective and prospective observational study using data from TREAT (Tokyo/tama-Registry of Acute Endovascular Thrombectomy), a multicenter registry of MT for acute LVO in the Tokyo metropolitan area. All subjects emergently transferred and treated with MT from January 2015 to December 2018 were selected. Patients' baseline characteristics and stroke-related parameters were evaluated. The primary outcome was the modified Rankin Scale (mRS) score 1 year after MT. The secondary outcomes were risk factors for long-term good outcomes (mRS score 0-2); transfer system (stroke bypass vs. secondary transfer) was also evaluated as a potential factor associated with good long-term outcomes.
A total of 162 cases (mean age 73.0 years, age range 30-97 years; 59.9% male) whose mRS scores at 1 year were obtained were analyzed. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 17. Overall, 42.6% of the patients achieved functional independence at 1-year follow-up. Lower initial NIHSS score and mRS score 0-2 at 90 days were the independent predictors for good long-term outcomes. Stroke bypass was associated with a higher initial NIHSS score and mRS score 0 at 1 year.
A significant number of patients experience a good long-term outcome after MT.
机械血栓切除术（MT）是治疗因大血管闭塞（LVO）引起的急性缺血性脑卒中患者的推荐治疗方法。然而，很少有研究调查 MT 后的长期结果。本研究旨在调查真实世界临床实践中接受 MT 治疗前循环 LVO 的患者在 MT 后长期随访（MT 后 1 年）的功能结果。
这是一项回顾性和前瞻性观察研究，使用了来自东京/ tama-急性血管内血栓切除术登记处（TREAT）的数据，这是东京大都市区急性 LVO 的 MT 多中心登记处。选择了 2015 年 1 月至 2018 年 12 月期间紧急转院并接受 MT 治疗的所有患者。评估了患者的基线特征和与中风相关的参数。主要结果是 MT 后 1 年的改良 Rankin 量表（mRS）评分。次要结果是长期良好结局（mRS 评分 0-2）的危险因素；还评估了转移系统（中风旁路与二次转移）作为与良好长期结局相关的潜在因素。
共分析了 162 例（平均年龄 73.0 岁，年龄 30-97 岁；59.9%为男性）患者的 mRS 评分在 1 年时获得的病例。入院时 NIHSS 评分中位数为 17。总体而言，42.6%的患者在 1 年随访时达到了功能独立。较低的初始 NIHSS 评分和 90 天 mRS 评分 0-2 是长期良好结局的独立预测因素。中风旁路与更高的初始 NIHSS 评分和 1 年 mRS 评分 0 相关。
大量患者在 MT 后可获得良好的长期结局。
