Department of Neurology, Hospital of Kunming Medical University, No. 295 Xi Chang Lu, Kunming, 650032, Yunnan Province, China.
Neurosurg Rev. 2023 May 4;46(1):103. doi: 10.1007/s10143-023-02013-4.
This study aimed to compare the clinical features, treatment, and clinical outcome of patients with tandem occlusion and isolated intracranial occlusion through endovascular treatment (EVT).
Patients with acute cerebral infarction who received EVT in two stroke centers were retrospectively included. According to MRI or CTA results, the patients were divided into tandem occlusion group or isolated intracranial occlusion group. The baseline data, etiological classification, treatment, post-stroke complications, image features, and clinical outcome were compared. Multivariate logistic regression analysis was used to evaluate the related factors affecting the prognosis of patients with EVT.
Among 161 patients with acute cerebral infarction, there were 33 cases (20.5%) in the tandem occlusion group and 128 cases (79.5%) in the isolated intracranial occlusion group. Compared with isolated intracranial occlusion, the patients with tandem occlusion had higher rates of large artery atherosclerosis (P = 0.028), symptomatic intracerebral hemorrhage (sICH) (P = 0.023), bilateral infarction (P = 0.042), and longer time for endovascular procedure (P = 0.026). There was no significant statistical difference in 90-day mRS score between the two groups (P = 0.060). Multivariate logistic regression identified the following independent predictors of poor functional outcome: older age, high fasting blood glucose, infarction area > 1/3, and hemorrhagic transformation.
Compared with isolated intracranial occlusion, there was not a worse prognosis among patients with tandem occlusion who received EVT.
本研究旨在通过血管内治疗（EVT）比较串联闭塞和孤立性颅内闭塞患者的临床特征、治疗方法和临床结局。
回顾性纳入在两家卒中中心接受 EVT 的急性脑梗死患者。根据 MRI 或 CTA 结果，将患者分为串联闭塞组或孤立性颅内闭塞组。比较两组患者的基线资料、病因分类、治疗方法、卒中后并发症、影像学特征和临床结局。采用多因素 logistic 回归分析评估影响 EVT 患者预后的相关因素。
在 161 例急性脑梗死患者中，串联闭塞组 33 例（20.5%），孤立性颅内闭塞组 128 例（79.5%）。与孤立性颅内闭塞相比，串联闭塞患者大血管粥样硬化（P = 0.028）、症状性颅内出血（sICH）（P = 0.023）、双侧梗死（P = 0.042）和血管内治疗时间更长（P = 0.026）的发生率更高。两组 90 天 mRS 评分无显著统计学差异（P = 0.060）。多因素 logistic 回归分析识别出预后不良的独立预测因素包括年龄较大、空腹血糖较高、梗死面积>1/3 和出血性转化。
与孤立性颅内闭塞相比，接受 EVT 的串联闭塞患者预后并未更差。
