Schwarz Ghil, Cascio Rizzo Angelo, Matusevicius Marius, Giussani Giuditta, Invernizzi Paolo, Melis Fabio, Lesko Norbert, Toni Danilo, Agostoni Elio Clemente, Ahmed Niaz
Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (G.S., A.C.R., G.G., E.C.A.).
Stroke Research Centre, University College London, Institute of Neurology, UK (G.S.).
Stroke. 2023 Mar;54(3):743-750. doi: 10.1161/STROKEAHA.122.041772. Epub 2023 Feb 27.
The benefit of distinguishing between disabling versus nondisabling deficit in mild acute ischemic stroke due to endovascular thrombectomy-targetable vessel occlusion (EVT-tVO; including anterior circulation large and medium-vessel occlusion) is unknown. We compared safety and efficacy of acute reperfusion treatments in disabling versus nondisabling mild EVT-tVO.
From the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register, we included consecutive acute ischemic stroke patients (2015-2021) treated within 4.5 hours, with full NIHSS items availability and score ≤5, evidence of intracranial internal carotid artery, M1, A1-2, or M2-3 occlusion. After propensity score matching, we compared efficacy (3-month modified Rankin Scale score of 0-1, modified Rankin Scale score of 0-2, and early neurological improvement) and safety (nonhemorrhagic early neurological deterioration, any intracerebral or subarachnoid hemorrhage, symptomatic intracranial hemorrhage, and death at 3-month) outcomes in disabling versus nondisabling patients-adopting an available definition.
We included 1459 patients. Propensity score matched analysis of disabling versus nondisabling EVT-tVO (n=336 per group) found no significant differences in efficacy (modified Rankin Scale score 0-1: 67.4% versus 71.5%, =0.336; modified Rankin Scale score 0-2: 77.1% versus 77.6%, =0.895; early neurological improvement: 38.3% versus 44.4%, =0.132) and safety (nonhemorrhagic early neurological deterioration: 8.5% versus 8.0%, =0.830; any intracerebral hemorrhage or subarachnoid hemorrhage: 12.5% versus 13.3%, =0.792; symptomatic intracranial hemorrhage: 2.6% versus 3.4%, =0.598; and 3-month death: 9.8% versus 9.2%, =0.844) outcomes.
We found similar safety and efficacy outcomes after acute reperfusion treatment in disabling versus nondisabling mild EVT-tVO; our findings suggest to adopt similar acute treatment approaches in the 2 groups. Randomized data are needed to clarify the best reperfusion treatment in mild EVT-tVO.
对于因血管内血栓切除术可靶向血管闭塞（EVT-tVO，包括前循环大、中血管闭塞）导致的轻度急性缺血性卒中，区分致残性与非致残性缺损的益处尚不清楚。我们比较了致残性与非致残性轻度EVT-tVO急性再灌注治疗的安全性和有效性。
从“卒中治疗的安全实施-国际卒中溶栓登记”中，我们纳入了在4.5小时内接受治疗的连续急性缺血性卒中患者（2015 - 2021年），其美国国立卫生研究院卒中量表（NIHSS）项目完整且评分≤5，有颅内颈内动脉、M1、A1 - 2或M2 - 3闭塞的证据。在倾向评分匹配后，我们采用现有的定义比较了致残性与非致残性患者的疗效（3个月改良Rankin量表评分为0 - 1、改良Rankin量表评分为0 - 2以及早期神经功能改善）和安全性（非出血性早期神经功能恶化、任何脑内或蛛网膜下腔出血、症状性颅内出血以及3个月时的死亡）结局。
我们纳入了1459例患者。对致残性与非致残性EVT-tVO（每组n = 336）进行倾向评分匹配分析发现，在疗效（改良Rankin量表评分为0 - 1：67.4%对71.5%，P = 0.336；改良Rankin量表评分为0 - 2：77.1%对77.6%，P = 0.895；早期神经功能改善：38.3%对44.4%，P = 0.132）和安全性（非出血性早期神经功能恶化：8.5%对8.0%，P = 0.830；任何脑内或蛛网膜下腔出血：12.5%对13.3%，P = 0.792；症状性颅内出血：2.6%对3.4%，P = 0.598；3个月时死亡：9.8%对9.2%，P = 0.844）结局方面无显著差异。
我们发现在致残性与非致残性轻度EVT-tVO中，急性再灌注治疗后的安全性和有效性结局相似；我们的研究结果表明在两组中采用相似的急性治疗方法。需要随机数据来明确轻度EVT-tVO的最佳再灌注治疗。
