Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Roma, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Roma, Italy.
Clin Neurol Neurosurg. 2020 Nov;198:106207. doi: 10.1016/j.clineuro.2020.106207. Epub 2020 Sep 7.
DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion. The aim of our study is to evaluate results of endovascular thrombectomy in large intracranial vessel occlusion without perfusion CT patient selection.
we reviewed our prospectively collected endovascular databases for patients with an acute stroke from March 2016 to October 2018, treated after 6 h from stroke onset, without perfusion CT selection. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0-2. The association between clinical and procedural parameters and functional outcome was assessed.
out of 212 patients 55 were treated after 6 h from stroke onset, 49 of which for an anterior circulation occlusion. 18/49 were functional independent at 90 days (mRS 0-2), Successful recanalization (mTICI 2b to 3) was achieved in 38/49 patients (77 %). Multivariate logistic regression indicated that a low baseline NIHSS was associated with favorable outcome (OR 0.66, 95 % CI 0.52-0.83, p-value 0.001).
in our retrospective analysis, baseline NIHSS is the only parameter that can predict good outcome (90-days mRS 0-2). We confirm data from recent papers assessing that perfusion CT can provide a better patients' selection compared to mCTA for large vessels occlusion treated beyond six hours from symptom onset.
DAWN 和 DEFUSE-3 试验表明，血管内血栓切除术对前循环大血管闭塞导致的迟发性急性缺血性脑卒中有益。我们的研究旨在评估不进行灌注 CT 选择的情况下，对大颅内血管闭塞患者进行血管内血栓切除术的结果。
我们回顾了 2016 年 3 月至 2018 年 10 月期间接受发病后 6 小时内治疗的急性脑卒中患者的前瞻性血管内数据库，没有进行灌注 CT 选择。评估了基线特征、手术数据和结果。良好的结果定义为 90 天改良 Rankin 量表评分为 0-2。评估了临床和手术参数与功能结果之间的关联。
在 212 例患者中，有 55 例在发病后 6 小时内接受治疗，其中 49 例为前循环闭塞。18/49 例患者在 90 天内达到功能独立性（mRS 0-2），49 例患者中有 38 例（77%）达到成功再通（mTICI 2b-3）。多变量逻辑回归表明，基线 NIHSS 较低与良好结局相关（OR 0.66，95%CI 0.52-0.83，p 值=0.001）。
在我们的回顾性分析中，基线 NIHSS 是唯一可以预测良好结局（90 天 mRS 0-2）的参数。我们证实了最近的一些论文的数据，即与 mCTA 相比，灌注 CT 可以为发病后 6 小时以上治疗的大血管闭塞患者提供更好的选择。
