Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
JAMA Netw Open. 2022 Aug 1;5(8):e2227139. doi: 10.1001/jamanetworkopen.2022.27139.
It is uncertain whether thrombectomy is associated with benefits in patients with prestroke disability.
To evaluate the use of thrombectomy for patients with large vessel occlusion and prestroke disability.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients with large vessel occlusion stroke and prestroke disability (modified Rankin Scale score, 3 or 4) admitted to a single tertiary care center between January 1, 2006, and June 30, 2019 (controls: 2006-2015; thrombectomy: 2015-2019). Follow-up was conducted at 90 days. Data analysis was performed from November 1 to December 31, 2021.
Use of thrombectomy vs no thrombectomy.
The primary outcome was functional recovery at 90 days defined as clinical recovery to the functional status before stroke onset. Secondary outcomes included functional dependency, mortality, early neurologic improvement, and recanalization.
Among 205 patients (149 women [72.7%]; median age, 82 years [IQR, 75-87 years]), 102 individuals (49.8%) received thrombectomy and 103 (50.2%) were controls. Thrombectomy was significantly associated with functional recovery (thrombectomy, 20 [19.6%]; controls, 8 [7.8%]; adjusted difference, 9.4%; 95% CI, 2.2% to 16.7%; P = .005). Secondary outcomes showed differences in mortality, early neurologic improvement, and recanalization in favor of thrombectomy treatment. The rate of functional dependency did not differ significantly between the 2 groups (adjusted difference, 8.9%; 95% CI, -2.5% to 20.2%; P = .13). The rate of functional recovery after thrombectomy was 44.0% for patients with early neurologic improvement, 29.4% for patients with small infarct volume (<50 mL), and 7.0% for patients with neither of these parameters.
Findings of this study suggest that selected patients with prestroke disability may benefit from thrombectomy. However, the thrombectomy-associated increase in functional recovery was small. Therefore, routine use of thrombectomy may not be beneficial among patients with a large ischemic core and infarct volumes less than 50 mL may be necessary to obtain functional recovery. Patients with higher chances of functional recovery are also at an increased risk of survival with substantial disability, indicating potential harms from the intervention; further studies are needed.
对于存在卒中前残疾的患者，取栓治疗是否有益尚不确定。
评估取栓治疗对存在大血管闭塞和卒中前残疾的患者的效果。
设计、地点和参与者：这项队列研究纳入了于 2006 年 1 月 1 日至 2019 年 6 月 30 日期间在一家三级护理中心因大血管闭塞性卒中且存在卒中前残疾（改良 Rankin 量表评分 3 或 4 分）而入院的患者（对照组：2006-2015 年；取栓组：2015-2019 年）。随访时间为 90 天。数据分析于 2021 年 11 月 1 日至 12 月 31 日进行。
使用取栓治疗与未使用取栓治疗。
主要结局为 90 天的功能恢复情况，定义为恢复到卒中发病前的功能状态。次要结局包括功能依赖、死亡率、早期神经改善和再通。
在 205 例患者（149 例女性[72.7%]；中位年龄 82 岁[IQR，75-87 岁]）中，102 例（49.8%）接受了取栓治疗，103 例（50.2%）为对照组。取栓治疗与功能恢复显著相关（取栓组 20 例[19.6%]；对照组 8 例[7.8%]；调整差异，9.4%；95%CI，2.2%16.7%；P=0.005）。次要结局显示，在死亡率、早期神经改善和再通方面，取栓治疗具有优势。2 组间功能依赖的发生率无显著差异（调整差异，8.9%；95%CI，-2.5%20.2%；P=0.13）。在早期神经改善的患者中，取栓后功能恢复的发生率为 44.0%，小梗死体积（＜50 mL）的患者为 29.4%，两者均不具备的患者为 7.0%。
本研究结果表明，存在卒中前残疾的部分患者可能从取栓治疗中获益。然而，取栓治疗相关的功能恢复增加幅度较小。因此，在存在较大缺血核心和梗死体积小于 50 mL 的患者中，常规使用取栓治疗可能无益，可能需要通过其他方法获得功能恢复。具有更高功能恢复可能性的患者的生存质量也存在明显残疾，表明该干预存在潜在危害，还需要进一步研究。
