Kwon Hanim, Lee Dongwhane, Lee Deok Hee, Suh Dae Chul, Kwon Sun U, Kang Dong-Wha, Kim Jong S
Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Stroke. 2022 May;24(2):245-255. doi: 10.5853/jos.2022.01095. Epub 2022 May 31.
We investigated the impact of stroke etiology on the endovascular treatment (EVT) procedure and clinical outcome of posterior circulation stroke (PCS) patients with EVT compared to anterior circulation stroke (ACS) patients.
We retrospectively analyzed ischemic stroke patients who underwent EVT between January 2012 and December 2020. Enrolled ACS and PCS patients were compared according to etiologies (intracranial arterial steno-occlusion [ICAS-O], artery-to-artery embolic occlusion [AT-O], and cardioembolic occlusion [CA-O]). EVT procedure and favorable clinical outcomes at 3 months (modified Rankin Scale 0-2) were compared between the ACS and PCS groups for each etiology.
We included 419 patients (ACS, 346; PCS, 73) including 88 ICAS-O (ACS, 67; PCS, 21), 66 AT-O (ACS, 50; PCS, 16), and 265 CA-O (ACS, 229; PCS, 36) patients in the study. The onset-to-recanalization time was longer in the PCS group than in the ACS group (median 628.0 minutes vs. 421.0 minutes, P=0.01). In CA-O patients, the door-to-puncture time was longer, whereas the puncture-to-recanalization time was shorter in the PCS group than in the ACS group. The proportions of successful recanalization and favorable clinical outcomes were similar between the ACS and PCS groups for all three etiologies. Low baseline National Institutes of Health Stroke Scale (NIHSS) scores and absence of intracerebral hemorrhage at follow-up imaging were associated with favorable clinical outcomes in both groups, whereas successful recanalization (odds ratio, 11.74; 95% confidence interval, 2.60 to 52.94; P=0.001) was only associated in the ACS group.
The proportions of successful recanalization and favorable clinical outcomes were similar among all three etiologies between PCS and ACS patients who underwent EVT. Initial baseline NIHSS score and absence of hemorrhagic transformation were related to favorable outcomes in the PCS and ACS groups, whereas successful recanalization was related to favorable outcomes only in the ACS group.
我们研究了卒中病因对接受血管内治疗（EVT）的后循环卒中（PCS）患者与前循环卒中（ACS）患者的EVT手术及临床结局的影响。
我们回顾性分析了2012年1月至2020年12月期间接受EVT的缺血性卒中患者。根据病因（颅内动脉狭窄闭塞[ICAS - O]、动脉到动脉栓塞闭塞[AT - O]和心源性栓塞闭塞[CA - O]）对纳入的ACS和PCS患者进行比较。比较ACS组和PCS组中每种病因的EVT手术及3个月时的良好临床结局（改良Rankin量表评分0 - 2）。
本研究纳入419例患者（ACS组346例，PCS组73例），其中包括88例ICAS - O患者（ACS组67例，PCS组21例）、66例AT - O患者（ACS组50例，PCS组16例）和265例CA - O患者（ACS组229例，PCS组36例）。PCS组从发病到再通的时间比ACS组长（中位数628.0分钟对421.0分钟，P = 0.01）。在CA - O患者中，PCS组从入院到穿刺的时间更长，而从穿刺到再通的时间比ACS组短。对于所有三种病因，ACS组和PCS组的成功再通率和良好临床结局比例相似。两组中，较低的基线美国国立卫生研究院卒中量表（NIHSS）评分以及随访影像学检查未发现脑出血与良好临床结局相关，而成功再通（优势比，11.74；95%置信区间，2.60至52.94；P = 0.001）仅与ACS组相关。
接受EVT的PCS和ACS患者在所有三种病因中的成功再通率和良好临床结局比例相似。初始基线NIHSS评分及无出血转化与PCS组和ACS组的良好结局相关，而成功再通仅与ACS组的良好结局相关。
