Division of Neurology, Department of Medicine, National University Health System, Singapore City, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
Eur J Neurol. 2021 Aug;28(8):2736-2744. doi: 10.1111/ene.14899. Epub 2021 May 25.
Endovascular thrombectomy (EVT) is the standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO). Young patients with AIS-LVO have distinctly different underlying stroke mechanisms and etiologies. Much is unknown about the safety and efficacy of EVT in this population of young AIS-LVO patients. All consecutive AIS-LVO patients aged 50 years and below were included in this multicenter cohort study. The primary outcome measured was functional recovery at 90 days, with modified Rankin Scale of 0-2 deemed as good functional outcome. A total of 275 AIS-LVO patients that underwent EVT from 10 tertiary centers in Germany, Sweden, Singapore, and Taiwan were included. Successful reperfusion was achieved in 85.1% (234/275). Good functional outcomes were achieved in 66.0% (182/275). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%). National Institutes of Health Stroke Scale (NIHSS) score at presentation was inversely related to good functional outcomes (aOR: 0.92, 95% CI: 0.88-0.96 per point increase, p < 0.001). Successful reperfusion (aOR: 3.22, 95% CI: 1.44-7.21, p = 0.005), higher ASPECTS (aOR: 1.21, 95% CI: 1.01-1.44, p = 0.036), and bridging intravenous thrombolysis (aOR: 2.37, 95% CI: 1.29-4.34, p = 0.005) independently predicted good functional outcomes. Successful reperfusion was inversely associated with in-hospital mortality (aOR: 0.14, 95% CI: 0.03-0.57, p = 0.006). History of hypertension strongly predicted in-hospital mortality (aOR: 4.59, 95% CI: 1.10-19.13, p = 0.036). While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS-LVO patients undergoing EVT.
血管内血栓切除术（EVT）是伴有大血管闭塞（LVO）的急性前循环缺血性卒中（AIS）的标准治疗方法。患有 AIS-LVO 的年轻患者具有明显不同的潜在卒中机制和病因。对于这一人群的年轻 AIS-LVO 患者，EVT 的安全性和有效性知之甚少。本多中心队列研究纳入了所有年龄在 50 岁及以下的 AIS-LVO 患者。主要观察结果为 90 天的功能恢复，改良 Rankin 量表 0-2 分被认为是良好的功能结局。该研究共纳入了来自德国、瑞典、新加坡和中国台湾的 10 个三级中心的 275 名接受 EVT 的 AIS-LVO 患者。85.1%（234/275）的患者实现了再灌注成功。275 名患者中，182 名（66.0%）实现了良好的功能结局。动脉夹层是最常见的卒中病因（42/195，21.5%）。入院时美国国立卫生研究院卒中量表（NIHSS）评分与良好的功能结局呈负相关（优势比：0.92，95%可信区间：每增加 1 分增加 0.88-0.96，p<0.001）。再灌注成功（优势比：3.22，95%可信区间：1.44-7.21，p=0.005）、较高的 ASPECTS（优势比：1.21，95%可信区间：1.01-1.44，p=0.036）和静脉溶栓桥接（优势比：2.37，95%可信区间：1.29-4.34，p=0.005）独立预测良好的功能结局。再灌注成功与住院期间死亡率呈负相关（优势比：0.14，95%可信区间：0.03-0.57，p=0.006）。高血压病史强烈预测住院期间死亡率（优势比：4.59，95%可信区间：1.10-19.13，p=0.036）。尽管不同的卒中病因之间存在功能结局的差异，但在接受 EVT 的年轻 AIS-LVO 患者中，再灌注成功和良好结局的比例通常较高。
