血管内治疗伴有大核心梗死缺血性卒中的通过次数：RESCUE-Japan LIMIT 的二次分析。

Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT.

机构信息

Department of Neurology, Japanese Red Cross Kumamoto Hospital, Japan (S.N.).

Department of Neurosurgery (K.U., S.Y., M.B., F.S., M.S.), Hyogo Medical University, Nishinomiya, Japan.

出版信息

Stroke. 2023 Aug;54(8):1985-1992. doi: 10.1161/STROKEAHA.123.042552. Epub 2023 Jul 7.

DOI:10.1161/STROKEAHA.123.042552

PMID:37417239

Abstract

BACKGROUND

The increased risk of intracranial hemorrhage with multiple passes in endovascular therapy (EVT) for large vessel occlusion with a large ischemic core is a concern. We explored the effect of the number of EVT passes on patients in a randomized clinical trial.

METHODS

This post hoc study was the secondary analysis of RESCUE-Japan LIMIT, which was a randomized clinical trial comparing EVT and medical treatment alone for large vessel occlusion with large ischemic core. We grouped patients according to the number of passes with successful reperfusion (modified Thrombolysis in Cerebral Infarction score, ≥2b) in 1, 2, and 3 to 7 passes and failed reperfusion (modified Thrombolysis in Cerebral Infarction score, 0-2a) after any pass in the EVT group, and these groups were compared with medical treatment group. The primary outcome was modified Rankin Scale score of 0 to 3 at 90 days. Secondary outcomes were improvement in National Institutes of Health Stroke Scale score of ≥8 at 48 hours, mortality at 90 days, symptomatic intracranial hemorrhage, and any intracranial hemorrhage within 48 hours.

RESULTS

The number of patients who received EVT with successful reperfusion after 1, 2, and 3 to 7 passes and failed reperfusion were 44, 23, 19, and 14, respectively, and 102 received medical treatment alone. The adjusted odds ratios (95% CIs) for the primary outcome relative to medical treatment were 5.52 (2.23-14.28) after 1 pass, 6.45 (2.22-19.30) after 2 passes, 1.03 (0.15-4.48) after 3 to 7 passes, and 1.17 (0.16-5.37) if reperfusion failed. The adjusted odds ratios (95% CIs) for any intracranial hemorrhage within 48 hours relative to medical treatment were 1.88 (0.90-3.93) after 1 pass, 5.14 (1.97-14.72) after 2 passes, 3.00 (1.09-8.58) after 3 to 7 passes, and 6.16 (1.87-24.27) if reperfusion failed.

CONCLUSIONS

The successful reperfusion within 2 passes was associated with better clinical outcomes.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03702413.

摘要

背景

血管内治疗（EVT）治疗大血管闭塞伴大缺血核心时多次通过会增加颅内出血的风险，这令人担忧。我们在一项随机临床试验中探讨了通过次数对患者的影响。

方法

本事后分析是 RESCUE-Japan LIMIT 的二次分析，该试验比较了 EVT 与单独药物治疗对大血管闭塞伴大缺血核心患者的疗效。我们根据 EVT 组中任何一次通过后成功再通（改良脑梗死溶栓评分，≥2b）和未成功再通（改良脑梗死溶栓评分，0-2a）的通过次数将患者分为 1 次、2 次和 3 至 7 次通过组，并将这些组与药物治疗组进行比较。主要结局为 90 天时改良 Rankin 量表评分为 0 至 3 分。次要结局为 48 小时内 NIHSS 评分提高≥8 分、90 天时死亡率、症状性颅内出血和 48 小时内任何颅内出血。

结果

成功再通 1 次、2 次、3 至 7 次和未成功再通的患者分别为 44 例、23 例、19 例和 14 例，102 例患者接受了单独药物治疗。与药物治疗相比，1 次通过的主要结局调整后比值比（95%CI）为 5.52（2.23-14.28），2 次通过为 6.45（2.22-19.30），3 至 7 次通过为 1.03（0.15-4.48），未成功再通为 1.17（0.16-5.37）。与药物治疗相比，48 小时内任何颅内出血的调整后比值比（95%CI）为 1 次通过为 1.88（0.90-3.93），2 次通过为 5.14（1.97-14.72），3 至 7 次通过为 3.00（1.09-8.58），未成功再通为 6.16（1.87-24.27）。