Department of Interventional Neuroradiology, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Beijing, 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Neurotherapeutics. 2022 Mar;19(2):501-512. doi: 10.1007/s13311-022-01189-9. Epub 2022 Mar 3.
This study aimed to investigate the safety and efficacy of endovascular treatment (EVT) in acute ischemic stroke (AIS) patients caused by large-vessel occlusion (LVO) with different etiologies of stroke. A total of 928 AIS patients were assigned into intracranial atherosclerotic stenosis (ICAS)-LVO, cardioembolic (CE)-LVO, and artery to artery embolism (ATA)-LVO groups. The safety and efficacy endpoints were symptomatic intracranial hemorrhage (SICH) at 24 h after EVT, 90-day favorable outcomes (modified Rankin Scale (mRS) of 0-2), successful recanalization (modified thrombolysis in cerebral infarct (mTICI) 2b/3), and complete recanalization (mTICI 3). The logistic regression analysis was used to determine the associations between the safety and efficacy endpoints. There were 305 (32.9%), 535 (57.6%), and 88 (9.5%) patients in ICAS-LVO, CE-LVO, and ATA-LVO groups, respectively. No significant difference was found in the 90-day mRS and successful recanalization among the three groups. However, compared with the ICAS-LVO group, complete recanalization rate was higher in the CE-LVO (adjusted odds ratio, 4.50; 95% confidence interval (CI), 2.37-8.56) and ATA-LVO groups (aOR, 2.43; 95% CI, 1.16-5.10). The results of subgroup analysis showed a significant association between CE-LVO stroke etiology and complete recanalization in the age population < 65 years old (aOR, 14.33; 95% CI, 4.39-46.79, P = 0.019). Functional outcomes were similar among different etiologies of stroke. CE-LVO and ATA-LVO could be related to a higher rate of complete recanalization, and there was a trend of the increased risk of parenchymal hemorrhage in the CE-LVO group.
本研究旨在探讨血管内治疗（EVT）在不同病因引起的大动脉闭塞（LVO）的急性缺血性卒中（AIS）患者中的安全性和疗效。928 例 AIS 患者被分为颅内动脉粥样硬化狭窄（ICAS）-LVO、心源性栓塞（CE）-LVO 和动脉到动脉栓塞（ATA）-LVO 组。安全性和疗效终点分别为 EVT 后 24 小时症状性颅内出血（SICH）、90 天良好结局（改良 Rankin 量表（mRS）0-2）、成功再通（改良脑梗死溶栓（mTICI）2b/3）和完全再通（mTICI 3）。采用逻辑回归分析确定安全性和疗效终点之间的关系。ICAS-LVO、CE-LVO 和 ATA-LVO 组分别有 305（32.9%）、535（57.6%）和 88（9.5%）例患者。三组之间 90 天 mRS 和成功再通无显著差异。然而，与 ICAS-LVO 组相比，CE-LVO（调整后的优势比，4.50；95%置信区间（CI），2.37-8.56）和 ATA-LVO 组的完全再通率更高（调整后的优势比，2.43；95%CI，1.16-5.10）。亚组分析结果表明，CE-LVO 病因与年龄<65 岁人群的完全再通有显著相关性（调整后的优势比，14.33；95%CI，4.39-46.79，P=0.019）。不同病因的卒中患者的功能结局相似。CE-LVO 和 ATA-LVO 可能与更高的完全再通率有关，而 CE-LVO 组的实质内出血风险有增加的趋势。
