支架取栓术治疗前循环与后循环缺血性卒中：STRATIS注册研究分析
Stent Retriever Thrombectomy for Anterior vs. Posterior Circulation Ischemic Stroke: Analysis of the STRATIS Registry.
作者信息
Jahan Reza, Liebeskind David S, Zaidat Osama O, Mueller-Kronast Nils H, Froehler Michael T, Saver Jeffrey L
机构信息
Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
出版信息
Front Neurol. 2021 Aug 23;12:706130. doi: 10.3389/fneur.2021.706130. eCollection 2021.
The benefits of mechanical thrombectomy (MT) in vertebrobasilar artery occlusions have not been well-studied. We compared clinical, procedural, and safety outcomes of MT for posterior circulation (PC) vs. anterior circulation (AC) occlusions among patients in the STRATIS registry. Data from STRATIS including patient demographics, procedural characteristics, and outcomes including symptomatic intracranial hemorrhage (sICH) at 24 h, serious adverse events (SAE), substantial reperfusion [modified thrombolysis in cerebral infarction (mTICI) 2b/3], 90-day functional independence [modified Rankin Scale (mRS) 0-2], and 90-day mortality were analyzed. Univariate logistic regression was used to calculate predictors of good clinical outcome. Of 984 STRATIS patients, 43 (4.4%) patients with PC occlusions [mean age 63.0 ± 13.6, 25.6% (11/43) female] and 932 (94.7%) with AC occlusions [mean age 68.5 ± 14.8, 46.9% (437/932) female] were included for analysis. Median National Institutes of Health Stroke Scale (NIHSS) scores at baseline were 17.0 (13.0, 12.0) for the AC group and 12.0 (11.0, 24.0) for the PC group. Time from onset to procedure end was longer for the PC group [median (IQR): 322.0 min (255.0-421.0) vs. 271.0 min (207.0-360.0); = 0.007]. PC and AC groups had similar rates of substantial reperfusion [89.2% (33/37) vs. 87.7% (684/780)], procedure-related SAE [0.0% (0/43) vs. 1.7% (16/932)], sICH [0.0% (0/38) vs. 1.5% (12/795)], 90-day functional independence [66.7% (26/39) vs. 55.9% (480/858)] and mortality [12.8% (5/39) vs. 15.8% (136/861)]. National Institutes of Health Stroke Scale score and patient sex were significant univariate predictors of good clinical outcome ( < 0.05). Despite longer reperfusion times, MT in PC stroke has similar rates of 90-day functional independence with no significant difference in procedure-related SAE, sICH, or mortality, supporting the use of MT in PC acute ischemic stroke (AIS). https://www.clinicaltrials.gov, Identifier: NCT02239640.
机械取栓术（MT）治疗椎基底动脉闭塞的益处尚未得到充分研究。我们比较了STRATIS注册研究中患者接受MT治疗后循环（PC）与前循环（AC）闭塞的临床、手术及安全性结局。分析了STRATIS的相关数据，包括患者人口统计学资料、手术特征以及结局，如24小时内症状性颅内出血（sICH）、严重不良事件（SAE）、显著再灌注[改良脑梗死溶栓（mTICI）2b/3级]、90天功能独立性[改良Rankin量表（mRS）0 - 2级]以及90天死亡率。采用单因素逻辑回归计算良好临床结局的预测因素。在984例STRATIS患者中，纳入分析的有43例（4.4%）PC闭塞患者[平均年龄63.0±13.6岁，25.6%（11/43）为女性]和932例（94.7%）AC闭塞患者[平均年龄68.5±14.8岁，46.9%（437/932）为女性]。AC组基线时美国国立卫生研究院卒中量表（NIHSS）评分中位数为17.0（13.0，12.0），PC组为12.0（11.0，24.0）。PC组从发病到手术结束的时间更长[中位数（四分位间距）：322.0分钟（255.0 - 421.0） vs. 271.0分钟（207.0 - 3,60.0）；P = 0.007]。PC组和AC组的显著再灌注率[89.2%（33/37） vs. 87.7%（684/780）]、与手术相关的SAE[0.0%（0/43） vs. 1.7%（十六/932）]、sICH[0.0%（0/38） vs. 1.5%（12/795）]、90天功能独立性[66.7%（26/39） vs. 55.9%（480/858）]及死亡率[12.8%（5/39） vs. 15.8%（136/861）]相似。NIHSS评分和患者性别是良好临床结局的显著单因素预测因素（P < 0.05）。尽管再灌注时间较长，但PC卒中患者接受MT治疗后的90天功能独立性发生率相似，在与手术相关的SAE、sICH或死亡率方面无显著差异，这支持在PC急性缺血性卒中（AIS）中使用MT。https://www.clinicaltrials.gov，标识符：NCT02239640 。
Zotero 插件