Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.
Faculty of Health, School of Medicine, University Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
Clin Neuroradiol. 2023 Sep;33(3):687-694. doi: 10.1007/s00062-023-01262-6. Epub 2023 Feb 6.
Whether patients presenting with mild stroke (NIHSS at admission < 6) should be treated with mechanical thrombectomy (MT) is the subject of an ongoing debate. This retrospective study based on large-scale clinical data aims to identify factors associated with favorable outcome (FO) in patients with mild stroke.
A total of 761 patients with mild stroke enrolled between 1 January 2020 and 31 December 2020 in the Quality Registry of the German Society for Neuroradiology were analyzed. The FO was defined as stable or improved NIHSS at discharge vs. admission. Descriptive statistics and multivariable logistic regression analyses were performed to identify factors associated with FO. Furthermore, a subgroup analysis of mild stroke based on distal vessel occlusion was conducted.
In this study 610 patients had FO with a median NIHSS at discharge of 1 (interquartile range, IQR, 0-2) and 151 had an unfavorable outcome (UO) with median NIHSS at discharge of 10 (IQR 13). Patients with FO had a slightly higher NIHSS at admission (4 vs. 3, p < 0.001), lower mTICI 0 (2.7% vs. 14.2%, p < 0.001), higher mTICI 3 (61.3% vs. 34.5%, p < 0.001) and a lower number of passes (1 vs. 2, p < 0.001). No statistically significant difference was observed for MT-related adverse events. Multivariable logistic regression suggested that NIHSS at admission (adjusted odds ratio (aOR) = 1.28, 95% confidence interval (CI) = 1.10-1.48), mTICI 2b (aOR = 5.44, CI = 2.06-15.03), mTICI 2c (aOR = 10.81, CI = 3.65-34.07) and mTICI 3 (aOR = 11.56, CI = 4.49-31.10) as well as number of passes (aOR 0.76, CI = 0.66-0.88) were significantly associated with FO. No MT-related adverse events were observed for distal vessel occlusions.
The FO in patients with mild stroke undergoing MT was associated with successful recanalization. No significant differences between patients with FO and UO were found for MT-related adverse events, suggesting that MT complications have no significant effects on the outcome of these patients. MT might improve the prognosis also in patients with mild stroke based on distal vessel occlusions without significantly increasing the risk of adverse events.
对于发病时 NIHSS 评分＜6 的轻度卒中患者，是否应采用机械取栓（MT）治疗，目前仍存在争议。本研究基于大规模临床数据，旨在探讨与轻度卒中患者良好预后（FO）相关的因素。
2020 年 1 月 1 日至 12 月 31 日期间，德国神经放射学会质量登记处共纳入 761 例轻度卒中患者。FO 定义为出院时 NIHSS 评分较入院时稳定或改善。采用描述性统计和多变量逻辑回归分析，确定与 FO 相关的因素。此外，还对基于远端血管闭塞的轻度卒中进行了亚组分析。
本研究中，610 例患者 FO，出院时 NIHSS 中位数为 1（四分位距 IQR，0-2），151 例患者 UO，出院时 NIHSS 中位数为 10（IQR 13）。FO 组患者入院时 NIHSS 评分略高（4 vs. 3，p＜0.001），mTICI 0 级（2.7% vs. 14.2%，p＜0.001）、mTICI 3 级（61.3% vs. 34.5%，p＜0.001）比例更高，以及治疗通路数更少（1 vs. 2，p＜0.001）。MT 相关不良事件无统计学显著差异。多变量逻辑回归提示，入院时 NIHSS（调整后优势比（aOR）=1.28，95%置信区间（CI）=1.10-1.48）、mTICI 2b（aOR=5.44，CI=2.06-15.03）、mTICI 2c（aOR=10.81，CI=3.65-34.07）和 mTICI 3（aOR=11.56，CI=4.49-31.10）以及治疗通路数（aOR 0.76，CI=0.66-0.88）与 FO 显著相关。远端血管闭塞患者未观察到 MT 相关不良事件。
MT 治疗轻度卒中患者的 FO 与再通效果有关。FO 组和 UO 组在 MT 相关不良事件方面无显著差异，提示 MT 并发症对这些患者的预后无显著影响。MT 可能改善基于远端血管闭塞的轻度卒中患者的预后，且不会显著增加不良事件风险。
