Department of Neurology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic.
Department of Radiology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic
J Neurointerv Surg. 2023 Sep;15(e1):e123-e128. doi: 10.1136/jnis-2022-019176. Epub 2022 Aug 24.
Acute ischemic stroke (AIS) due to anterior circulation tandem lesion (TL) remains a technical and clinical challenge for endovascular treatment (EVT). Conflicting results from observational studies and missing evidence from the randomized trials led us to report a recent real-world multicenter clinical experience and evaluate possible predictors of good outcome after EVT.
We analyzed all AIS patients with TL enrolled in the prospective national study METRICS (Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers). A good 3-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS), achieved recanalization using the Thrombolysis In Cerebral Infarction (TICI) scale and symptomatic intracerebral hemorrhage (sICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria.
Of 1178 patients enrolled in METRICS, 194 (19.2%) (59.8% males, mean age 68.7±11.5 years) were treated for TL. They did not differ in mRS 0-2 (48.7% vs 46.7%; p=0.616), mortality (17.3% vs 22.7%; p=0.103) and sICH (4.7% vs 5.1%; p=0.809) from those with single occlusion (SO). More TL patients with prior intravenous thrombolysis (IVT) reached TICI 3 (70.3% vs 50.8%; p=0.012) and mRS 0-2 (55.4% vs 34.4%; p=0.007) than those without IVT. No difference was found in the rate of sICH (6.2% vs 1.6%; p=0.276). Multivariate logistic regression analysis showed prior IVT as a predictor of mRS 0-2 after adjustment for potential confounders (OR 3.818, 95% CI 1.614 to 9.030, p=0.002).
Patients with TL did not differ from those with SO in outcomes after EVT. TL patients with prior IVT had more complete recanalization and mRS 0-2 and IVT was found to be a predictor of good outcome after EVT.
由于前循环串联病变（TL）导致的急性缺血性脑卒中（AIS）仍然是血管内治疗（EVT）的技术和临床挑战。观察性研究的结果相互矛盾，随机试验中也缺乏证据，这促使我们报告最近的真实世界多中心临床经验，并评估 EVT 后良好预后的可能预测因素。
我们分析了参与前瞻性国家研究 METRICS（捷克中风中心机械血栓切除术质量指标研究）的所有 TL 急性缺血性脑卒中患者。改良 Rankin 量表（mRS）评分 0-2 分为 3 个月时临床预后良好，采用血栓溶解治疗脑梗死（TICI）量表评估再通，根据安全实施溶栓治疗监测研究（SITS-MOST）标准评估症状性颅内出血（sICH）。
在 METRICS 纳入的 1178 名患者中，194 名（19.2%）（59.8%为男性，平均年龄 68.7±11.5 岁）接受 TL 治疗。他们在 mRS 0-2（48.7% vs 46.7%；p=0.616）、死亡率（17.3% vs 22.7%；p=0.103）和 sICH（4.7% vs 5.1%；p=0.809）方面与单一闭塞（SO）患者无差异。有静脉溶栓（IVT）史的 TL 患者 TICI 3 的比例（70.3% vs 50.8%；p=0.012）和 mRS 0-2 的比例（55.4% vs 34.4%；p=0.007）高于无 IVT 史的患者。sICH 发生率（6.2% vs 1.6%；p=0.276）无差异。多变量逻辑回归分析显示，在调整潜在混杂因素后，IVT 史是 mRS 0-2 的预测因素（OR 3.818，95%CI 1.614 至 9.030，p=0.002）。
TL 患者与 SO 患者在 EVT 后结局无差异。有 IVT 史的 TL 患者再通程度更完全，mRS 0-2 评分更高，IVT 是 EVT 后良好预后的预测因素。
