预测卒中取栓术后早期神经功能恶化（END）的因素。

Predictors of early neurologic deterioration (END) following stroke thrombectomy.

机构信息

Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA

Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.

出版信息

J Neurointerv Surg. 2023 Jun;15(6):584-588. doi: 10.1136/neurintsurg-2022-018844. Epub 2022 May 18.

DOI:10.1136/neurintsurg-2022-018844

PMID:35584910

Abstract

BACKGROUND

Early neurologic deterioration (END) following ischemic stroke is a serious event and is associated with poor outcomes. However, the incidence and predictors of END after stroke thrombectomy for emergent large vessel occlusion are largely unknown.

METHODS

The baseline characteristics of patients enrolled in the COMPASS trial (NCT02466893) were analyzed. The primary outcome was worsening of ≥4 National Institutes of Health Stroke Scale (NIHSS) points 24 hours post thrombectomy (4+ END) and the secondary outcome was deterioration of ≥2 points (2+ END).

RESULTS

Among 270 patients, 27 (10%) developed 4+ END and 42 (16%) had 2+ END. Those with 4+ END were older (76.4±12.9 vs 70.9±12.9 years; p=0.04), had a higher prevalence of hypertension (96% vs 69%; p=0.003), diabetes (41% vs 27%; p=0.13) and higher pretreatment systolic blood pressure (SBP) (170.4±32.6 vs 157.6±28.1 mmHg; p=0.03). More 4+ END patients had failed reperfusion: Thrombolysis in Cerebral Infarction ≤2a (26% vs 8%; p=0.003). In unadjusted analysis, older patients and those with hypertension, diabetes, elevated SBP and failed reperfusion had higher odds of 4+ END. In adjusted analysis, age increase by 5 years led to an increase in 4+ END of 28%, diabetes increased odds of 2.6 and failed reperfusion increased odds of 4.5. In the multivariable analysis for the secondary outcome, age (OR 1.33; 95% CI 1.109 to 1.593), diabetes (OR 2.7; 95% CI 1.247 to 5.764) and failed reperfusion (OR 7.2; 95% CI 0.055 to 0.349) were also significant predictors of 2+ END.

CONCLUSIONS

Older patients with acute ischemic stroke who have a history of diabetes or hypertension, with elevated pretreatment SBP and failed reperfusion are at a higher risk of END following stroke thrombectomy for emergent large vessel occlusion.

摘要

背景

缺血性卒中后早期神经功能恶化（END）是一种严重事件，与不良结局相关。然而，接受血管内取栓治疗的急性大血管闭塞性卒中患者发生 END 的发生率和预测因素尚不清楚。

方法

对 COMPASS 试验（NCT02466893）入组患者的基线特征进行分析。主要结局为取栓后 24 小时 NIHSS 评分增加≥4 分（4+ END），次要结局为 NIHSS 评分增加≥2 分（2+ END）。

结果

270 例患者中，27 例（10%）发生 4+ END，42 例（16%）发生 2+ END。4+ END 组患者年龄较大（76.4±12.9 岁 vs 70.9±12.9 岁；p=0.04），高血压（96% vs 69%；p=0.003）、糖尿病（41% vs 27%；p=0.13）和较高的治疗前收缩压（SBP）（170.4±32.6mmHg vs 157.6±28.1mmHg；p=0.03）更为常见。更多 4+ END 患者存在再通失败：血栓切除术再通率≤2a（26% vs 8%；p=0.003）。在未校正分析中，年龄较大、合并高血压、糖尿病、SBP 升高和再通失败的患者 4+ END 发生率更高。在校正分析中，年龄每增加 5 岁，4+ END 的发生率增加 28%，糖尿病使 2+ END 的风险增加 2.6 倍，再通失败使 4+ END 的风险增加 4.5 倍。在次要结局的多变量分析中，年龄（OR 1.33；95%CI 1.109 至 1.593）、糖尿病（OR 2.7；95%CI 1.247 至 5.764）和再通失败（OR 7.2；95%CI 0.055 至 0.349）也是 2+ END 的显著预测因素。