评估与最佳药物治疗相比，机械取栓术对美国国立卫生研究院卒中量表（NIHSS）评分<6且表现为大脑中动脉近端血管闭塞患者的疗效。
Assessing the Efficacy of Mechanical Thrombectomy in Patients with an NIHSS < 6 Presenting with Proximal Middle Cerebral Artery Vessel Occlusion as Compared to Best Medical Management.
作者信息
Yedavalli Vivek Srikar, Hamam Omar, Gudenkauf Julie, Wang Richard, Llinas Rafael, Marsh Elisabeth Breese, Caplan Justin, Nael Kambiz, Urrutia Victor
机构信息
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA.
Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD 21205, USA.
出版信息
Brain Sci. 2023 Jan 27;13(2):214. doi: 10.3390/brainsci13020214.
BACKGROUND AND PURPOSE
Minor acute ischemic stroke (AIS) patients-defined by an NIHSS score < 6-presenting with proximal middle cerebral artery large vessel occlusions (MCA-LVO) is a subgroup for which treatment is still debated. Although these patients present with minor symptoms initially, studies have shown that several patients afflicted with MCA-LVO in this subgroup experience cognitive and functional decline. Although mechanical thrombectomy (MT) is the standard of care for patients with an NIHSS score of 6 or higher, treatment in the minor stroke subgroup is still being explored. The purpose of this preliminary study is to report our center's experience in evaluating the potential benefit of mechanical thrombectomy (MT) in minor stroke patients when compared to medical management (MM).
METHODS
We performed a retrospective study with two comprehensive stroke centers within our hospital enterprise of consecutive patients presenting with minor AIS secondary to MCA-LVO (defined as M1 or proximal M2 segments of MCA). We subsequently evaluated patients who received MT versus those who received MM.
RESULTS
Between January 2017 and July 2021, we identified 46 AIS patients (11 treated with MT and 35 treated with MM) who presented with an NIHSS score < 6 secondary to MCA-LVO (47.8% 22/46 female, mean age 62.3 years, range 49-75 years). MT was associated with a significantly lower mRS at 90 days (median: 1.0 [IQR 0.0-2.0] versus 3.0 [IQR 1.0-4.0], = <0.001), a favorable NIHSS shift (-4.0 [IQR -10.0--2.0] versus 0.0 [IQR -2.0-1.0], = 0.002), favorable NIHSS shift dichotomization (5/11, 45.5% versus 3/35, 8.6%, = 0.003) and favorable mRS dichotomization (7/11, 63.6% versus 14/35, 40.0%, = 0.024).
CONCLUSIONS
In our center's preliminary experience, for AIS patients presenting with an NIHSS score < 6 secondary to MCA-LVO, MT may be associated with improved clinical outcomes when compared to MM only.
背景与目的
美国国立卫生研究院卒中量表（NIHSS）评分＜6分的轻度急性缺血性卒中（AIS）患者，若伴有大脑中动脉近端大血管闭塞（MCA-LVO），其治疗方案仍存在争议。尽管这些患者最初症状较轻，但研究表明，该亚组中部分患有MCA-LVO的患者会出现认知和功能衰退。虽然机械取栓术（MT）是NIHSS评分6分及以上患者的标准治疗方法，但轻度卒中亚组的治疗仍在探索中。本初步研究的目的是报告我们中心在评估机械取栓术（MT）与药物治疗（MM）相比，对轻度卒中患者潜在益处方面的经验。
方法
我们在我院两个综合卒中中心进行了一项回顾性研究，纳入连续出现因MCA-LVO（定义为MCA的M1段或近端M2段）导致的轻度AIS患者。随后，我们对接受MT治疗的患者与接受MM治疗的患者进行了评估。
结果
2017年1月至2021年7月期间，我们确定了46例AIS患者（11例接受MT治疗，35例接受MM治疗），这些患者因MCA-LVO导致NIHSS评分＜6分（47.8%，22/46为女性，平均年龄62.3岁，范围49 - 75岁）。MT组在90天时改良Rankin量表（mRS）评分显著更低（中位数：1.0[四分位间距0.0 - 2.0] vs 3.0[四分位间距1.0 - 4.0]，P＜0.001），NIHSS评分有有利的变化（-4.0[四分位间距-10.0 - -2.0] vs 0.0[四分位间距-2.0 - 1.0]，P = 0.002），NIHSS评分有利变化的二分法（5/11，45.5% vs 3/35，8.6%，P = 0.003）以及mRS评分有利变化的二分法（7/11，63.6% vs 14/35，40.0%，P = 0.024）。
结论
根据我们中心的初步经验，对于因MCA-LVO导致NIHSS评分＜6分的AIS患者，与单纯MM相比，MT可能会带来更好的临床结局。
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