Department of Diagnostic and Interventional Neuroradiology (F.F., C.B., G.B., H.L., R.M., T.D.F., J.F.), University Medical Center Hamburg-Eppendorf, Germany.
Department of Neurology (M.D.-C., A.A., G.T.), University Medical Center Hamburg-Eppendorf, Germany.
Stroke. 2021 Jan;52(2):482-490. doi: 10.1161/STROKEAHA.120.029830. Epub 2021 Jan 20.
Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. Often, more than one retrieval attempt is needed to achieve reperfusion. We aimed to quantify the influence of endovascular therapy on clinical outcome depending on the number of retrievals needed for successful reperfusion in a large multi-center cohort.
For this observational cohort study, 2611 patients from the prospective German Stroke Registry included between June 2015 and April 2018 were analyzed. Patients who received endovascular therapy for acute anterior circulation stroke with known admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction score, and number of retrievals were included. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. The primary outcome was defined as functional independence (modified Rankin Scale score of 0-2) at day 90. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers and confounders.
The inclusion criteria were met by 1225 patients. The odds of good clinical outcome decreased with every retrieval attempt required for successful reperfusion: the first retrieval had the highest odds of good clinical outcome (adjusted odds ratio, 6.45 [95% CI, 4.0-10.4]), followed by the second attempt (adjusted odds ratio, 4.56 [95% CI, 2.7-7.7]), and finally the third (adjusted odds ratio, 3.16 [95% CI, 1.8-5.6]).
Successful reperfusion within the first 3 retrieval attempts is associated with improved clinical outcome compared with patients without reperfusion. We conclude that at least 3 retrieval attempts should be performed in endovascular therapy of anterior circulation strokes. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03356392.
血管内治疗是治疗大血管闭塞性急性缺血性脑卒中的标准治疗方法。通常需要多次取栓尝试才能实现再灌注。我们旨在通过大样本多中心队列研究，量化血管内治疗对临床结局的影响，具体取决于成功再灌注所需的取栓次数。
本研究为前瞻性德国卒中登记研究的观察性队列研究，共纳入 2015 年 6 月至 2018 年 4 月期间的 2611 例患者。本研究纳入了接受血管内治疗的急性前循环卒中患者，这些患者具有已知的入院国立卫生研究院卒中量表评分和 Alberta 卒中项目早期 CT 评分、最终的血栓切除术溶栓评分和取栓次数。成功再灌注定义为血栓切除术溶栓评分 2b 或 3。主要结局为 90 天的功能独立性（改良 Rankin 量表评分为 0-2）。采用多变量混合效应模型对参与中心的聚类效应和混杂因素进行调整。
1225 例患者符合纳入标准。随着成功再灌注所需的取栓次数的增加，良好临床结局的可能性降低：第一次取栓具有最高的良好临床结局的可能性（调整后的优势比，6.45 [95%可信区间，4.0-10.4]），其次是第二次尝试（调整后的优势比，4.56 [95%可信区间，2.7-7.7]），最后是第三次（调整后的优势比，3.16 [95%可信区间，1.8-5.6]）。
与未再灌注患者相比，在前 3 次取栓尝试内成功再灌注与改善的临床结局相关。我们得出结论，在前循环卒中的血管内治疗中，至少应进行 3 次取栓尝试。
