成功的血栓切除术对卒中前有残疾的患者有益：一项国际多中心队列研究的结果。
Successful thrombectomy is beneficial in patients with pre-stroke disability: Results from an international multicenter cohort study.
作者信息
Ducroux Célina, Derex Laurent, Nourredine Mikaïl, Haesebaert Julie, Buisson Marielle, Alesefir Walid, Boisseau William, Daneault Nicole, Deschaintre Yan, Diestro Jose Danilo B, Eker Omer, Eneling Johanna, Gioia Laura C, Iancu Daniella, Jacquin Grégory, Odier Céline, Stapf Christian, Raymond Jean, Roy Daniel, Weill Alain, Lapergue Bertrand, Poppe Alexandre Y
机构信息
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada; Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal, 900 rue St-Denis, Bureau R04-758, Montréal, QC H2X 0A9, Canada.
Department of Neurology, Stroke Center, Neurological Hospital, Hospices Civils de Lyon, University of Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France.
出版信息
J Neuroradiol. 2023 Feb;50(1):59-64. doi: 10.1016/j.neurad.2022.03.006. Epub 2022 Mar 25.
BACKGROUND
Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion.
METHODS
Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.
RESULTS
Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).
CONCLUSION
In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.
背景
大多数急性卒中血管内血栓切除术（EVT）试验将卒中前残疾患者排除在外，卒中前残疾定义为改良Rankin量表（mRS）评分≥3分。我们旨在评估已知残疾的卒中患者接受EVT后与良好预后相关的预后因素，以及成功再灌注的影响。
方法
回顾性收集2016年至2019年间来自加拿大队列和法国多中心队列（缺血性卒中血管内治疗登记处-ETIS）的连续急性卒中且有卒中前残疾并接受EVT的患者。良好预后定义为mRS评分等于卒中前mRS评分。将实现成功再灌注（定义为改良脑梗死溶栓评分2b/3分）的患者与未实现成功再灌注的患者进行比较，以确定成功的EVT是否与更好的功能结局相关。
结果
在6220例接受EVT治疗的患者中，纳入了280例（4.5%）卒中前mRS评分≥3分的患者。61例（21.8%）患者预后良好，146例（52.1%）在3个月时死亡。与未成功再灌注的患者相比，成功再灌注的患者90天mRS评分良好的比例更高（27.6%对19.6%，p = 0.025），死亡率更低（48.3%对69.6%，p = 0.008）。在调整基线预后因素后，由脑梗死溶栓分级（TICI）≥2b定义的成功再灌注与良好的功能结局相关（比值比3.16，95%置信区间[1.11 - 11.5]；p = 0.048）。
结论
在有卒中前残疾的患者中，成功再灌注与更高比例的良好预后和更低的死亡率相关。
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