Sreedharan Sapna Erat, Arun K, Kannath Santhosh, Jayadevan E R, Thulaseedharan Jissa V, Sylaja P N
Department of Neurology, Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Ann Indian Acad Neurol. 2022 Mar-Apr;25(2):256-260. doi: 10.4103/aian.aian_909_21. Epub 2022 Mar 25.
Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion.
The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019.
There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12-21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8-10) in 39 (31.6%) and fair (5-7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (<6 h) versus wake up strokes and late presenting patients (81.79% vs 71.9%). Symptomatic Intracerebral hemorrhage (ICH) occurred in 5%. At 3 months, excellent outcome (modified rankin scale <2) was observed in 28.9%. While Admission NIHSS remained strong predictor of poor outcome at 3 months, delay in presentation did not impact MT outcome (37.5% vs 45.79% and = 0.460).
The recanalization rates were similar in patients irrespective of the time to reperfusion from stroke onset. The functional outcome was not inferior in late presenters selected by advanced imaging.
及时有效的再通以挽救半暗带是急性缺血性卒中预后的主要决定因素。关于晚期窗内机械取栓（MT）的随机对照试验已证明其在卒中发作后24小时内的安全性和有效性。我们研究了再灌注时间对接受MT治疗大血管闭塞患者血管再通率和短期预后的影响。
从2012年1月至2019年9月前瞻性维护的缺血性卒中数据库中提取所有在最后一次正常状态后24小时内接受MT治疗患者的临床、影像学和预后数据。
共有145例患者，平均（标准差）年龄为58.2（±14）岁。其中，28例为醒后/发病时间不明的卒中患者，9例发病时间超过360分钟。有23例椎基底动脉卒中。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为16.4（四分位间距（IQR）12 - 21）。在前循环卒中患者中，39例（31.6%）的CT - 阿尔伯塔卒中项目早期CT评分（CT - ASPECTS）为优（8 - 10分），77例（63.6%）为中等（5 - 7分）。约25%的患者接受了桥接治疗。早期就诊（<6小时）患者与醒后卒中患者及晚期就诊患者的再通率无差异（81.79%对71.9%）。症状性颅内出血（ICH）发生率为5%。在3个月时，28.9%的患者获得了良好预后（改良Rankin量表评分<2）。虽然入院时NIHSS评分仍然是3个月时预后不良的有力预测指标，但就诊延迟并未影响MT治疗的预后（37.5%对45.79%，P = 0.460）。
无论从卒中发作到再灌注的时间如何，患者的再通率相似。通过先进影像学筛选出的晚期就诊患者的功能预后并不差。
