Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, Guangzhou, China.
Interv Neuroradiol. 2024 Oct;30(5):625-636. doi: 10.1177/15910199221133164. Epub 2022 Oct 20.
To identify and compare the predictors of failure of early neurological improvement (fENI)after successful EVT for anterior circulation large vessel occlusion (ACLVO) and posterior circulation LVO (PCLVO).
Subjects were selected from the ANGEL-ACT registry. fENI was defined as unchanged or worsened in National Institutes of Health Stroke Scale score (NIHSS) between admission and 24 h after EVT. Predictors of fENI after successful EVT (mTICI 2b-3) were determined via center-adjusted analyses. Univariable and multivariable comparisons between ACLVO and PCLVO were performed.
A total of 1447 patients, 1128 were with ACLVO, and 319 were with PCLVO. Among the patients with ACLVO, there were 409 patients (36.3%) with fENI and 719 patients (63.7%) with ENI. We observed that pre-stroke mRS scale score of 2 (odd ratio[OR] 95% confidence interval[CI], 6.93[1.99-24.10], P = 0.002), initial NIHSS score (OR per point[95%CI], 0.97[0.95-0.99], P = 0.012), diabetes (OR[95%CI], 1.56[1.08-2.25], P = 0.017), previous ICH (OR[95%CI] 9.21[1.76-48.15], P = 0.008), local anesthesia (OR[95%CI] 1.63[1.10-2.42], P = 0.014), onset-to-puncture time (OR[95%CI], 1.001[1.000-1.001], P = 0.009), symptomatic ICH (OR[95%CI] 3.90[2.27-6.69], P < 0.001), and continued use of tirofiban within 2 h after EVT (OR[95%CI], 0.69[0.51-0.93], P = 0.014) were independent predictors of fENI of ACLVO after EVT. Among the patients with PCLVO, there were 112 patients (35.1%) with fENI and 207 patients (64.9%) with ENI. In contrast, admission SBP (OR[95%CI], 0.98[0.97-0.99], P = 0.012), and vascular dissection within 2 h after EVT (OR[95%CI], 7.23[1.33-39.13], P = 0.022) were independent predictors of fENI of PCLVO after EVT.
In selected patients, successful EVT can lead to similar outcomes in PCLVO and ACLVO. Some predictors of fENI in both anterior circulation and posterior circulation were identified in our study, which should be highly considered in the clinical practice in LVO patients undergoing EVT.
识别并比较成功血管内治疗（EVT）后前循环大血管闭塞（ACLVO）和后循环大血管闭塞（PCLVO）患者早期神经功能改善失败（fENI）的预测因素。
从 ANGEL-ACT 登记处选择受试者。fENI 定义为 EVT 后 24 小时内入院和 NIHSS 评分之间无变化或恶化。通过中心调整分析确定成功 EVT（mTICI 2b-3）后的 fENI 预测因素。对 ACLVO 和 PCLVO 进行单变量和多变量比较。
共纳入 1447 例患者，其中 1128 例为 ACLVO，319 例为 PCLVO。在 ACLVO 患者中，有 409 例（36.3%）发生 fENI，719 例（63.7%）发生 ENI。我们观察到，术前 mRS 评分 2 分（比值比[OR]95%置信区间[CI]，6.93[1.99-24.10]，P=0.002）、初始 NIHSS 评分（每分 OR[95%CI]，0.97[0.95-0.99]，P=0.012）、糖尿病（OR[95%CI]，1.56[1.08-2.25]，P=0.017）、既往 ICH（OR[95%CI]9.21[1.76-48.15]，P=0.008）、局部麻醉（OR[95%CI]1.63[1.10-2.42]，P=0.014）、发病至穿刺时间（OR[95%CI]，1.001[1.000-1.001]，P=0.009）、症状性 ICH（OR[95%CI]3.90[2.27-6.69]，P<0.001）和 EVT 后 2 小时内继续使用替罗非班（OR[95%CI]0.69[0.51-0.93]，P=0.014）是 ACLVO 患者 EVT 后 fENI 的独立预测因素。在 PCLVO 患者中，有 112 例（35.1%）发生 fENI，207 例（64.9%）发生 ENI。相比之下，入院时 SBP（OR[95%CI]0.98[0.97-0.99]，P=0.012）和 EVT 后 2 小时内血管夹层（OR[95%CI]7.23[1.33-39.13]，P=0.022）是 PCLVO 患者 EVT 后 fENI 的独立预测因素。
在选择的患者中，成功的 EVT 可以在前循环和后循环中产生相似的结果。我们的研究确定了前后循环中 fENI 的一些预测因素，在接受 EVT 的 LVO 患者的临床实践中应高度考虑这些因素。
