Neurology, First People's Hospital of Foshan, Foshan, Guangdong, China.
Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China.
Stroke Vasc Neurol. 2024 Apr 30;9(2):126-133. doi: 10.1136/svn-2022-002257.
The impact of thrombus migration (TM) prior to endovascular thrombectomy (EVT) on clinical outcomes and revascularisation rates remains unknown. We aimed to examine whether preinterventional TM modifies the treatment effects of direct EVT versus bridging EVT in acute large vessel occlusion patients.
All patients undergoing catheter angiography in the Direct Intra-arterial thrombectomy in order to Revascularise acute ischaemic stroke patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: A Multicentre randomised clinical Trial were included. TM was determined by radiologists unaware of the study by analysing discrepancies between computed tomographic angiography at baseline and first-run digital subtraction angiography before EVT. The primary outcome was the score on the modified Rankin scale (mRS) assessed at 90 days.
Of 627 included patients, the TM rate was 11.3% (71/627). In the multivariable logistic regression model, baseline National Institutes of Health Stroke Scale score (adjusted OR 0.956, 95% CI 0.916 to 0.999; p=0.043) and intravenous thrombolysis (adjusted OR 2.614, 95% CI 1.514 to 4.514; p<0.001) were independently associated with TM. The patients with TM were less likely to be completely recanalised than those without TM (21.27% vs 36.23%, p=0.040). The interaction of TM and the EVT treatment effect did not significantly affect mRS shift analysis (p=0.687) or mRS scores of 0 to 1 (p=0.436).
Preinterventional TM does not modify the treatment effects of direct versus bridging EVT on functional outcomes in patients with acute ischaemic stroke with anterior large vessel occlusion. TM leads to a lower complete recanalisation rate.
血管内血栓切除术（EVT）前血栓迁移（TM）对临床结局和再血管化率的影响尚不清楚。我们旨在研究急性大血管闭塞患者中，直接 EVT 与桥接 EVT 治疗前 TM 是否改变了治疗效果。
所有在直接动脉内血栓切除术以有效恢复急性大血管闭塞的中国三级医院缺血性卒中患者的再灌注：多中心随机临床试验中接受导管血管造影的患者均被纳入。由不知晓研究的放射科医生通过分析 EVT 前基线计算机断层血管造影与首次运行数字减影血管造影之间的差异来确定 TM。主要结局是 90 天时改良 Rankin 量表（mRS）评分。
在纳入的 627 例患者中，TM 发生率为 11.3%（71/627）。在多变量逻辑回归模型中，基线国立卫生研究院卒中量表评分（调整后 OR 0.956，95%可信区间 0.916 至 0.999；p=0.043）和静脉溶栓（调整后 OR 2.614，95%可信区间 1.514 至 4.514；p<0.001）与 TM 独立相关。与无 TM 的患者相比，TM 患者完全再通的可能性较小（21.27%比 36.23%，p=0.040）。TM 与 EVT 治疗效果的相互作用对 mRS 变化分析无显著影响（p=0.687）或 mRS 评分 0 至 1（p=0.436）。
急性前大血管闭塞性缺血性卒中患者中，介入前 TM 并不改变直接与桥接 EVT 对功能结局的治疗效果。TM 导致完全再通率较低。
