From the Department of Clinical Neurosciences, Calgary Stroke Program (O.V., C.Z., M.N., A.M.D., B.K.M., M.D.H.), and Department of Community Health Sciences (C.Z., B.K.M., M.D.H.), Cumming School of Medicine, University of Calgary, Canada; International Clinical Research Centre, Stroke Research Program & Department of Neurology (O.V., P.C., R.M.), and Department of Medical Imaging (P.C.), St. Anne's University Hospital; Faculty of Medicine (O.V., P.C., R.M.), Masaryk University, Brno; Department of Neurology (O.V.), Faculty Hospital Ostrava; 2nd Medical Faculty (A.T.) and First Faculty of Medicine and General University Hospital (J.F.), Department of Neurology, Charles University, Prague; Department of Neurology, Faculty of Medicine (M.B.), University Hospital Ostrava, University Ostrava; Department of Radiology, 2nd Faculty of Medicine (M.R., R.P.), Charles University in Prague and Motol University Hospital; Department of Radiology (F.C.) and Department of Neurology-Comprehensive Stroke Center (D.C.), Masaryk Hospital, Usti nad Labem; Department of Neurology (M.N.), Hospital Ceske Budejovice; Neurocenter (L.J.), Regional Hospital Liberec; Department of Neurology (R.H.), Military University Hospital, Prague; Department of Neurology (M.K.), Na Homolce Hospital, Prague; Department of Neurology, Faculty of Medicine in Pilsen (P.S., V.R.), Charles University in Prague, Pilsen; Department of Neurology (R.J.), University Hospital Brno and Faculty of Medicine Masaryk University; Department of Neurology (D.V.), AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Czech Republic; Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR) (J.P.), Parc Sanitari Pere Virgili, Barcelona; Girona Biomedical Research Institute (IDIBGI)-Medical Imaging (J.P.), Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain; Department of Clinical Neurosciences (D.P.), University of Western Ontario; Lawson Health Research Institute and Robarts Research Institute (A.V.K.), London, Canada; and Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (E.F.), University of Florence, Italy.
Neurology. 2020 Dec 15;95(24):e3364-e3372. doi: 10.1212/WNL.0000000000010955. Epub 2020 Sep 28.
To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIH Stroke Scale (NIHSS) score ≤6 using datasets of multicenter and multinational nature.
We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS ≤6. Primary outcome was modified Rankin Scale (mRS) score 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of ≥2 points), mRS 0-2 at 90 days, and 90-day all-cause mortality. We used propensity score matching to adjust for nonrandomized treatment allocation.
Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared to medical management, the EVT group was younger (65 vs 72 years; < 0.001), had more proximal occlusions ( < 0.001), and less frequently received concurrent IV thrombolysis (57.7% vs 71.2%; = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% confidence interval [CI] -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI, 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours.
EVT for LVO in patients with low NIHSS score was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days.
This study provides Class III evidence that for patients with acute anterior circulation ischemic strokes and LVO with NIHSS < 6, EVT and medical management result in similar outcomes at 90 days.
利用多中心、多国家数据集，对 NIH 卒中量表（NIHSS）评分≤6 的急性大脑中动脉闭塞（LVO）患者的血管内治疗（EVT）的有效性和安全性进行分析。
我们纳入了来自 3 个国际前瞻性队列研究的前循环闭塞患者。如果患者从最后一次已知状态良好开始发病时间在 12 小时内，并且基线 NIHSS 评分≤6，则符合纳入标准。主要结局为 90 天改良 Rankin 量表（mRS）评分 0-1。次要结局包括 24 小时神经功能恶化（NIHSS 评分增加≥2 分）、90 天 mRS 评分 0-2 和 90 天全因死亡率。我们采用倾向评分匹配来调整非随机治疗分配的影响。
在符合纳入标准的 236 例患者中，139 例接受了 EVT 治疗，97 例接受了药物治疗。与药物治疗相比，EVT 组更年轻（65 岁 vs 72 岁；<0.001），病变更接近血管起始段（<0.001），且同时接受静脉溶栓治疗的比例更低（57.7% vs 71.2%；=0.04）。经倾向评分匹配后，两组的临床结局无显著差异。尽管 EVT 组患者在 24 小时的神经功能恶化风险增加了 22.3%（95%置信区间，3.0%-41.6%），但在 90 天时的良好临床结局率却高出了 8.6%（95%置信区间，-8.8%至 26.1%）。
对于 NIHSS 评分较低的急性大脑中动脉闭塞患者，EVT 治疗与 24 小时内的神经功能恶化风险增加相关。然而，EVT 和药物治疗在 90 天时都导致了相似比例的良好临床结局。
本研究提供了 III 级证据，表明对于 NIHSS<6 的急性前循环缺血性脑卒中合并大脑中动脉闭塞的患者，EVT 和药物治疗在 90 天时的结局相似。
