在晚期时间窗内对 M2 段 MCA 闭塞患者进行血管内治疗的结果。
Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window.
机构信息
From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada.
Diagnostic and Interventional Neuroradiology Department (F.B.), University Hospital of Tours, Tours, France.
出版信息
AJNR Am J Neuroradiol. 2023 Apr;44(4):447-452. doi: 10.3174/ajnr.A7833. Epub 2023 Mar 23.
BACKGROUND AND PURPOSE
Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset.
MATERIALS AND METHODS
Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6-24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b-3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion.
RESULTS
Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25-3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11-7.29).
CONCLUSIONS
In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.
背景与目的
在晚期时间窗进行的随机试验已经证明了血管内血栓切除术治疗大血管闭塞的疗效和安全性。这些试验排除了 M2 段 MCA 闭塞的患者。我们比较了发病后 6-24 小时内接受血管内血栓切除术治疗的 M2 段与 M1 段闭塞患者的结局。
材料与方法
分析来自于接受血管内血栓切除术治疗、发病后 6-24 小时的患者的研究汇总数据。我们比较了 90 天功能独立性（mRS≤2）、死亡率、症状性颅内出血和成功再灌注（扩展 TICI=2b-3）在 M2 与 M1 段闭塞患者之间的差异。然后评估了 M2 段闭塞患者成功再灌注的获益。
结果
在 461 名患者中，367 名（79.6%）患者存在 M1 段闭塞，94 名（20.4%）患者存在 M2 段闭塞。M2 段闭塞患者年龄较大，基线 NIHSS 评分中位数较低。与 M1 段闭塞患者相比，M2 段闭塞患者更有可能在 90 天内实现功能独立性（调整 OR=2.13；95%CI，1.25-3.65）。两组患者成功再灌注的比例（82.9%与 81.1%）或死亡率（11.2%与 17.2%）无显著差异。与 M1 段闭塞患者相比，M2 段闭塞患者症状性颅内出血风险较低（4.3%与 12.2%，P=.03）。成功再灌注与 M2 段闭塞患者的功能独立性独立相关（调整 OR=2.84；95%CI，1.11-7.29）。
结论
在晚期时间窗，与 M1 段闭塞患者相比，接受血管内血栓切除术治疗的 M2 段闭塞患者临床结局更好，再灌注相似，症状性颅内出血发生率更低。这些结果支持在晚期时间窗对 M2 段闭塞患者进行血管内血栓切除术治疗的安全性和获益。
Zotero 插件