Hyogo College of Medicine, Department of Neurosurgery, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
Kobe City Medical Center General Hospital, Department of Neurosurgery, Kobe City, Japan.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105625. doi: 10.1016/j.jstrokecerebrovasdis.2021.105625. Epub 2021 Jan 23.
To clarify the relationship between early neurological symptoms and long-term functional outcomes of acute ischemic stroke, which would be beneficial for patient management and determining clinical study criteria of novel therapeutic interventions.
We retrieved data from the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) and investigated the association between 24- and 72-hour National Institutes of Health Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores, stratified by the site of occlusion (carotid or vertebrobasilar circulatory large arterial occlusion [ACO or PCO, respectively]) and endovascular recanalization therapy (EVT) performance. We examined the correlation using Spearman's rank correlation coefficient (rho). Predictive accuracies of 24- and 72-hour NIHSS scores for good outcomes at 90 days (defined as mRS score of 0-2) were evaluated by receiver operating characteristic (ROC) analyses and the corresponding areas under the curves (AUCs).
Among the 2420 patients, 1745 had ACO (971 with EVT, 774 without EVT) and 263 had PCO (127 with EVT, 136 without EVT). The 24- and 72-hour NIHSS scores were significantly associated with 90-day mRS scores and accurately predicted good outcomes (all rhos ≥0.76, all AUCs ≥0.86). In the ACO group, there were differences in rho and AUC depending on EVT performance and the time from onset to NIHSS acquisition, but no differences were observed in the PCO group.
EVT performance and time frame should be considered when determining the criteria of novel therapeutic interventions, especially for patients with ACO.
阐明急性缺血性脑卒中早期神经症状与长期功能结局之间的关系，这有利于患者管理和确定新型治疗干预措施的临床研究标准。
我们从血管内治疗急性大脑超急性栓塞的日本登记研究 2 期（RESCUE-Japan Registry 2）中检索数据，并调查了闭塞部位（颈内动脉或椎基底动脉大循环闭塞，分别为 ACO 或 PCO）和血管内再通治疗（EVT）表现对 24 小时和 72 小时美国国立卫生研究院卒中量表（NIHSS）和 90 天改良 Rankin 量表（mRS）评分的相关性，评分按 90 天 mRS 评分（定义为 0-2 分为预后良好）分层。采用 Spearman 秩相关系数（rho）对相关性进行检验。通过受试者工作特征（ROC）分析和相应曲线下面积（AUC）评估 24 小时和 72 小时 NIHSS 评分对 90 天预后良好的预测准确性。
在 2420 例患者中，1745 例为 ACO（971 例接受 EVT，774 例未接受 EVT），263 例为 PCO（127 例接受 EVT，136 例未接受 EVT）。24 小时和 72 小时 NIHSS 评分与 90 天 mRS 评分显著相关，且能准确预测良好结局（所有 rho 值≥0.76，所有 AUC 值≥0.86）。ACO 组中，EVT 表现和发病至 NIHSS 采集时间对 rho 值和 AUC 值有影响，但 PCO 组无差异。
在确定新型治疗干预措施的标准时，应考虑 EVT 表现和时间框架，尤其是对 ACO 患者。
