Xu Xiangjun, Yang Ke, Xu Junfeng, Yang Qian, Guo Yapeng, Xu Youqing, Wang Hao, Ge Liang, Zhou Zhiming, Huang Xianjun
Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China.
Neuroradiology. 2023 Mar;65(3):609-618. doi: 10.1007/s00234-022-03078-6. Epub 2022 Nov 5.
The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes.
Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90 days after stroke.
Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0-2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality.
Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90 days. The optimal management for MCAO patients with different aetiologies requires further research.
本研究旨在评估不同病理亚型的大脑中动脉M1段闭塞（MCAO）患者血管内治疗（EVT）结局的差异。
2014年7月至2020年12月接受EVT的MCAO患者分为三组：无颈内动脉狭窄闭塞的栓塞（MCAO-E）、原位动脉粥样硬化血栓形成（MCAO-AS）和串联颈内动脉狭窄闭塞所致的栓塞（MCAO-T）。比较各组的基线特征、EVT相关因素和临床结局。进行多变量回归分析以评估病因分类与卒中后90天结局之间的关系。
在符合条件的患者（n = 220）中，MCAO-E（n = 129，58.6%）是最常见的病因，其次是MCAO-AS（n = 47，21.4%）和MCAO-T（n = 44，20.0%）。与MCAO-AS患者相比，MCAO-E患者年龄显著更大，但血脂异常和吸烟史发生率更低。尽管MCAO-AS和MCAO-T患者更常需要补救性球囊血管成形术和支架置入术（p < 0.001），但最终再通率无显著差异。MCAO-AS组患者获得了更好的功能结局（90天改良Rankin量表评分，0 - 2）（p = 0.002），且死亡率低于MCAO-E组（p = 0.009）。在多变量逻辑回归分析中，我们未发现卒中亚型是功能结局和死亡率的独立预测因素。
不同病因所致急性大脑中动脉M1段闭塞性卒中患者在90天时具有相当的成功再通率和功能独立性。不同病因的MCAO患者的最佳治疗方案需要进一步研究。
