Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
JAMA Netw Open. 2022 Oct 3;5(10):e2235733. doi: 10.1001/jamanetworkopen.2022.35733.
Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.
To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019.
The primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis.
Endovascular treatment.
Of 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P < .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P < .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285).
In this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.
仅有有限的数据表明，血管内治疗（EVT）对在延长时间窗内出现且有广泛梗死迹象的缺血性脑卒中患者可能有益。
评估 EVT 后再通与在延长时间窗内出现且有广泛梗死迹象的缺血性脑卒中患者功能结局之间的关联。
设计、地点和参与者：这项回顾性、多中心队列研究纳入了在德国卒中登记处-血管内治疗中接受治疗的患者，这些患者的 Alberta 卒中项目早期 CT 评分（ASPECTS）为 5 或更低，在卒中发病后 6 至 24 小时之间出现，并在 2015 年 7 月 1 日至 2019 年 12 月 31 日之间进行了计算机断层扫描和随后的 EVT。
主要终点是第 90 天改良 Rankin 量表（mRS）评分 3 或更低。使用逻辑回归和逆概率加权分析评估再通（定义为改良血栓溶解评分达到 2b 或 3）与结局之间的关联。
血管内治疗。
在 5853 例患者中，有 285 例（5%；146 例男性[51%]；中位年龄为 73 岁[IQR，62-81 岁]）符合纳入标准并进行了分析。这 285 例患者中，79 例（27.7%）在第 90 天的 mRS 评分为 3 或更低。再通率为 75%（215/285），且与更高的 mRS 评分 3 或更低的可能性独立相关（调整后的优势比，4.39；95%CI，1.79-10.72；P < .001）。在逆概率加权分析中，改良血栓溶解评分达到 2b 或 3 与 mRS 评分 3 或更高的概率增加 19%相关（95%CI，9%-29%；P < .001）。多变量逻辑回归分析表明，在时间窗长达 17.6 小时且 ASPECTS 为 3 至 5 的情况下，血管再通与治疗有显著获益相关。继发性症状性颅内出血的发生率为 6.3%（285 例中有 18 例）。
在这项反映日常临床实践的队列研究中，对于 ASPECTS 较低且时间窗延长的患者进行血管再通与在时间窗长达 17.6 小时且 ASPECTS 为 3 至 5 的情况下更好的功能结局相关。这项研究的结果鼓励目前的随机临床试验招募 ASPECTS 较低的患者，即使在延长的时间窗内也是如此。
