Ha Sang Hee, Ryu Jae-Chan, Bae Jae-Han, Koo Sujin, Kwon Boseong, Lee Deok Hee, Chang Jun Young, Kang Dong-Wha, Kwon Sun U, Kim Jong-Sung, Kim Bum Joon
Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea,
Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7.
Endovascular thrombectomy (EVT) has benefits in selected patients 6-24 h after stroke onset. However, the response to EVT >24 h after stroke onset is still unclear. We compared the early response to EVT in patients with different time windows.
Patients who underwent EVT in an emergency setting were enrolled and categorized according to when EVT was performed: within 6 (early), 6-24 (late), and >24 h (very late) after stroke onset. Early neurological improvement (ENI) and deterioration (END) were defined as improvement and worsening, respectively, of National Institutes of Health Stroke Scale (NIHSS) score by ≥4 points after EVT. The three groups' clinical characteristics and response to EVT were compared. We also investigated factors associated with ENI and END.
During study period, 274 patients underwent EVT (109 early, 104 late, and 61 very late). Patients who underwent EVT very late were younger (p = 0.007), had smaller ischemic cores, and had lower initial NIHSS scores (8 ± 5) than those who underwent EVT early (14 ± 6) and late (13 ± 7; p < 0.001). Stroke mechanisms also differed according to the time window (p < 0.001): cardioembolism was more common after early EVT, whereas large-artery atherosclerosis was more prevalent among patients who underwent EVT very late. ENI was significantly more common after early (60.6%) and late EVT (51.0%) than after very late EVT (29.5%; p = 0.001); however, rates of END did not differ (11.0%, 13.5%, and 4.9%, respectively). ENI was independently associated with male, higher NIHSS score, and early and late EVT. END was associated with failure of recanalization.
ENI was more observed and associated with early and late EVT. Highly selected patients receiving very late EVT may not benefit from ENI but may still have a chance to prevent END. The occurrence of END was associated not with time window but with failure of recanalization.
血管内血栓切除术（EVT）对卒中发作后6 - 24小时的特定患者有益。然而，卒中发作后超过24小时接受EVT的反应仍不明确。我们比较了不同时间窗患者对EVT的早期反应。
纳入在急诊环境中接受EVT的患者，并根据EVT的实施时间进行分类：卒中发作后6小时内（早期）、6 - 24小时（晚期）和超过24小时（极晚期）。早期神经功能改善（ENI）和恶化（END）分别定义为EVT后美国国立卫生研究院卒中量表（NIHSS）评分改善和恶化≥4分。比较三组的临床特征和对EVT的反应。我们还研究了与ENI和END相关的因素。
在研究期间，274例患者接受了EVT（109例早期，104例晚期，61例极晚期）。极晚期接受EVT的患者比早期（14±6）和晚期（13±7；p<0.001）接受EVT的患者更年轻（p = 0.007），缺血核心更小，初始NIHSS评分更低（8±5）。卒中机制也因时间窗而异（p<0.001）：早期EVT后心源性栓塞更常见，而极晚期接受EVT的患者中大动脉粥样硬化更普遍。早期（60.6%）和晚期EVT（51.0%）后ENI明显比极晚期EVT后（29.5%；p = 0.001）更常见；然而，END的发生率没有差异（分别为11.0%、13.5%和4.9%）。ENI与男性、较高的NIHSS评分以及早期和晚期EVT独立相关。END与再通失败相关。
ENI在早期和晚期EVT中更常观察到且与之相关。高度选择的极晚期接受EVT的患者可能无法从ENI中获益，但仍可能有机会预防END。END的发生与时间窗无关，而是与再通失败有关。
