Université de Lille, Inserm U1172, Department of Neurology, Stroke unit, CHU de Lille, Lille, France.
Université de Lille, CHU de Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France.
Rev Neurol (Paris). 2021 Oct;177(8):955-963. doi: 10.1016/j.neurol.2020.09.011. Epub 2021 Jan 21.
The net clinical benefit of mechanical thrombectomy (MT) in patients presenting acute anterior circulation ischemic stroke with large-vessel occlusion (AIS-LVO) and mild neurological deficit is uncertain.
To investigate efficacy and safety of MT in patients with acute AIS-LVO and mild neurological deficit by evaluating i) the influence of recanalisation on three-month outcome and ii) mortality, symptomatic intracerebral hemorrhage (sICH) and procedural complications.
We included consecutive patients with acute AIS-LVO and National Institute of Stroke Scale (NIHSS) score<8, treated by MT at Lille University Hospital. Recanalisation was graded according to modified thrombolysis in cerebral infarction (mTICI) score, mTICI 2b/2c/3 being considered successful. We recorded procedural complications and classified intra-cerebral hemorrhages (ICH) and sICH according with European Cooperative Acute Stroke Study (ECASS) and ECASS2 criteria. Three-month outcome was evaluated by modified Rankin scale (mRS). Excellent and favourable outcomes were respectively defined as mRS 0-1 and 0-2 (or similar to pre-stroke).
We included 95 patients. At three months, 56 patients (59. 0%) achieved an excellent outcome and 69 (72, 6%) a favourable outcome, both being more frequent in patients with successful recanalisation than in patients without (excellent outcome 71, 1% versus 10, 5%, P<0.001 and favourable outcome 82.9% versus 31.6%, P<0.001). The difference remained unchanged after adjustment for age and pre-MT infarct volume. Similar results were observed in patients with pre-MT NIHSS ≤5. Death occurred in five patients (5.3%), procedural complications in 12 (12.6%), any ICH in 38 (40.0%), including 3 (3.2%) sICH.
Achieving successful recanalisation appears beneficial and safe in acute AIS-LVO patients with NIHSS<8 before MT.
机械取栓（MT）治疗急性前循环大血管闭塞性脑梗死（AIS-LVO）伴轻度神经功能缺损患者的净临床获益尚不确定。
通过评估 i）再通对 3 个月结局的影响和 ii）死亡率、症状性颅内出血（sICH）和程序并发症，探讨 MT 治疗急性 AIS-LVO 伴轻度神经功能缺损患者的疗效和安全性。
我们纳入了在里尔大学医院接受 MT 治疗的急性 AIS-LVO 伴 NIHSS 评分<8 的连续患者。再通程度根据改良脑梗死溶栓（mTICI）评分进行分级，mTICI 2b/2c/3 为再通成功。我们记录了程序并发症，并根据欧洲合作急性卒中研究（ECASS）和 ECASS2 标准对颅内出血（ICH）和 sICH 进行分类。3 个月结局采用改良 Rankin 量表（mRS）进行评估。良好和优效结局分别定义为 mRS 0-1 和 0-2（或类似于卒中前）。
我们纳入了 95 例患者。3 个月时，56 例（59.0%）患者获得了良好结局，69 例（72.6%）患者获得了优效结局，再通成功患者的比例明显高于未再通患者（良好结局 71.1%比 10.5%，P<0.001；优效结局 82.9%比 31.6%，P<0.001）。调整年龄和 MT 前梗死体积后，差异仍然存在。在 MT 前 NIHSS≤5 的患者中也观察到了类似的结果。5 例患者死亡（5.3%），12 例（12.6%）患者出现程序并发症，38 例（40.0%）患者发生任何 ICH，包括 3 例（3.2%）sICH。
在 MT 前 NIHSS<8 的急性 AIS-LVO 患者中，实现再通似乎是有益且安全的。
