Zhang Yiran, Hong Lan, Ling Yifeng, Yang Lumeng, Li Siyuan, Cheng Xin, Dong Qiang
Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
Front Aging Neurosci. 2022 Oct 10;14:884087. doi: 10.3389/fnagi.2022.884087. eCollection 2022.
Randomized clinical trials and large stroke registries have demonstrated a time-dependent benefit of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The aim of this study was to investigate whether this could be applied to different stroke subtypes in a real-world single-center cohort.
Consecutive ischemic stroke patients with LVOs presenting within 24 h after symptom onset were prospectively registered and retrospectively assessed. Baseline multimodal imaging was conducted before EVT. Independent predictors of functional independence [90-day modified Rankin scale (mRS), 0-2] and any incidence of intracranial hemorrhage (ICH) were explored using a stepwise logistic regression model in the entire cohort and in stroke subtypes.
From 2015 to 2020, 140 eligible patients received EVT, of whom 59 (42%) were classified as large artery atherosclerosis (LAA)-related. Time from last known normal to groin puncture was identified as an independent predictor for functional independence in patients of cardioembolic (CE) subtype [odds ratio (OR) 0.90 per 10 min; 95% CI 0.82-0.98; = 0.013] but not in the LAA subtype and the whole cohort. Groin puncture within 6 h after the time of last known normal was associated with a lower risk of any ICH in the whole cohort (OR 0.36, 95% CI 0.17-0.75, = 0.007). Sensitivity analysis of patients with complete imaging profiles also confirmed the above findings. Besides, compared with patients of the CE subtype, the LAA subtype had a smaller baseline ischemic core volume, a better collateral status, a slower core growth rate, and a numerically smaller final infarct volume.
Faster groin puncture has a more pronounced effect on the functional outcome in patients of CE subtype than those of LAA subtype. Reducing time to groin puncture is of great importance in improving the prognosis of patients after EVT, especially those of CE subtype, and reducing the incidence of any ICH in all patients.
随机临床试验和大型卒中登记研究表明，血管内治疗（EVT）对因大血管闭塞（LVO）导致的急性缺血性卒中（AIS）患者具有时间依赖性益处。本研究的目的是调查这是否适用于真实世界单中心队列中的不同卒中亚型。
对症状发作后24小时内出现LVO的连续性缺血性卒中患者进行前瞻性登记和回顾性评估。在EVT前进行基线多模态成像。使用逐步逻辑回归模型在整个队列和卒中亚型中探索功能独立（90天改良Rankin量表[mRS]，0 - 2）和颅内出血（ICH）任何发生率的独立预测因素。
2015年至2020年，140例符合条件的患者接受了EVT，其中59例（42%）被归类为大动脉粥样硬化（LAA）相关。从最后已知正常到股动脉穿刺的时间被确定为心源性栓塞（CE）亚型患者功能独立的独立预测因素[每10分钟优势比（OR）0.90；95%置信区间0.82 - 0.98；P = 0.013]，但在LAA亚型和整个队列中并非如此。在最后已知正常时间后6小时内进行股动脉穿刺与整个队列中任何ICH的较低风险相关（OR 0.36，95%置信区间0.17 - 0.75，P = 0.007）。对具有完整成像资料患者的敏感性分析也证实了上述发现。此外，与CE亚型患者相比，LAA亚型患者的基线缺血核心体积较小、侧支循环状态较好、核心生长速度较慢且最终梗死体积在数值上较小。
更快的股动脉穿刺对CE亚型患者功能结局的影响比对LAA亚型患者更显著。减少股动脉穿刺时间对于改善EVT后患者的预后非常重要，尤其是CE亚型患者，并降低所有患者中任何ICH的发生率。
