Kim Beom Joon, Menon Bijoy K, Yoo Joonsang, Han Jung Hoon, Kim Bum Joon, Kim Chi Kyung, Kim Jae Guk, Kim Joon-Tae, Park Hyungjong, Baik Sung Hyun, Han Moon-Ku, Kang Jihoon, Kim Jun Yup, Lee Keon-Joo, Park Jong-Moo, Kang Kyusik, Lee Soo Joo, Cha Jae-Kwan, Kim Dae-Hyun, Jeong Jin-Heon, Park Tai Hwan, Park Sang-Soon, Lee Kyung Bok, Lee Jun, Hong Keun-Sik, Cho Yong-Jin, Park Hong-Kyun, Lee Byung-Chul, Yu Kyung-Ho, Oh Mi-Sun, Kim Dong-Eog, Ryu Wi-Sun, Choi Kang-Ho, Choi Jay Chol, Kim Joong-Goo, Kwon Jee-Hyun, Kim Wook-Joo, Shin Dong-Ick, Yum Kyu Sun, Sohn Sung-Il, Hong Jeong-Ho, Kim Chulho, Lee Sang-Hwa, Lee Juneyoung, Almekhlafi Mohammed A, Demchuk Andrew, Bae Hee-Joon
Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Front Neurol. 2022 Aug 5;13:955725. doi: 10.3389/fneur.2022.955725. eCollection 2022.
There is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.
From a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.
Among 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6-12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63-1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59-12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5-41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23-1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0-1 in mild LVO patients without END (adjusted OR, 0.63 [0.40-0.99]).
The use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.
急性大血管闭塞（LVO）且伴有轻度神经功能缺损的患者在血管内治疗（EVT）决策方面存在诸多不确定性。
从一项前瞻性的全国性卒中登记研究中，纳入所有在最后一次已知健康状态（LKW）后24小时内出现LVO且基线美国国立卫生研究院卒中量表（NIHSS）评分<6的患者。前瞻性收集在EVT之前发生的早期神经功能恶化（END），定义为住院期间NIHSS总分增加≥2分或NIHSS意识或运动子评分出现任何与EVT无关的恶化。严重出血定义为PH2型出血转化或远处部位出血。前瞻性收集3个月时的改良Rankin量表（mRS）评分。
在1083例患者中，149例（14%）患者在LKW后中位时间5.9[3.6 - 12.3]小时接受了EVT。在倾向评分匹配分析中，EVT与mRS 0 - 1评分无关（匹配比值比0.99[0.6 .3 - 1.54]），但增加了严重出血的风险（匹配比值比，4.51[1.59 - 12.80]）。207例（19%）患者在LKW后中位时间24.5小时[四分位间距，13.5 - 41.9小时]出现无关END（发生率，每100人小时1.4 .[95%置信区间，1.23 - 1.62]）。与EVT无关的END显示出改变EVT疗效的趋势（交互作用P值，0.08），这降低了无END的轻度LVO患者获得mRS 0 - 1评分的几率（校正比值比，0.63[0.4 . - 0.99]）。
在急性LVO且NIHSS评分较低的患者中使用EVT可能需要评估早期恶化、出血并发症的个体风险以及预期获益。
