桥接治疗与大血管闭塞性卒中后认知功能改善相关——德国卒中登记处的一项分析
Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke - an analysis of the German Stroke Registry.
作者信息
Ettelt Philipp, Maier Ilko L, Schnieder Marlena, Bähr Mathias, Behme Daniel, Psychogios Marios-Nikos, Liman Jan
机构信息
Department of Neurology, Allgemeines Krankenhaus Celle, Celle, Germany.
Department of Neurology, University Medicine Göttingen, Göttingen, Germany.
出版信息
Neurol Res Pract. 2020 Jul 27;2:29. doi: 10.1186/s42466-020-00079-9. eCollection 2020.
BACKGROUND
The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear.
METHODS
We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT).
RESULTS
Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, = 0.65). Median MoCA score in the EVT + IVT group was 20 pts. (18-25 IQR) vs. 18 pts. (16-21 IQR) in the EVT-IVT group ( = 0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT + IVT group (78 patients (76%)). EVT + IVT was associated with a higher MoCA score at 90 days (mRS ≤ 2: = 0.033, B = 2.39; mRS = 0: = 0.021, B = 4.38).
CONCLUSIONS
In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03356392.
背景
在急性大脑大血管闭塞性卒中（LVOS）中，靶向使用血管内治疗（EVT），无论是否联合静脉溶栓（IVT），已被证明比单纯IVT更具优势。尽管功能预后良好，但许多患者在接受EVT后抱怨出现认知功能下降。IVT联合EVT对认知功能是否有积极影响尚不清楚。
方法
我们分析了来自德国卒中登记处（GSR，一项开放、多中心的前瞻性观察性研究）的数据，并使用蒙特利尔认知评估量表（MoCA）比较了接受联合EVT和IVT（EVT + IVT）与单纯接受EVT（EVT - IVT）且功能预后独立（改良Rankin量表[mRS]≤2分）和良好（mRS = 0分）的缺血性卒中患者在首次缺血性卒中后90天的认知功能。
结果
在2636例GSR患者中，我们纳入了166例在90天时mRS≤2的患者进行分析。其中，103例患者（62%）接受了EVT + IVT，63例患者（38%）仅接受了EVT治疗。两组之间的再灌注状态无差异（两组95%的患者脑梗死溶栓分级[mTICI]≥2b，P = 0.65）。EVT + IVT组的MoCA评分中位数为20分（四分位间距[IQR]为18 - 25），而EVT - IVT组为18分（IQR为16 - 21）（P = 0.014）。与EVT + IVT组（78例患者[76%]）相比，EVT - IVT组（54例患者[86%]）中有更多认知障碍（定义为MoCA < 26分）的患者。EVT + IVT与90天时更高的MoCA评分相关（mRS≤2：P = 0.033，B = 2.39；mRS = 0：P = 0.021，B = 4.38）。
结论
在LVOS后功能预后良好的患者中，与单纯EVT相比，联合EVT和IVT的认知障碍发生率更低。
试验注册
ClinicalTrials.gov标识符：NCT03356392。
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