Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States.
Assistant Professor of Neurology and Neurosurgery, Department of Neurology, University of Chicago, 5941 S Maryland Ave., MC 2030, Chicago, IL 60637-1470, United States.
J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107227. doi: 10.1016/j.jstrokecerebrovasdis.2023.107227. Epub 2023 Jul 10.
Data on large vessel occlusion (LVO) management due to intracranial atherosclerotic disease (ICAD) are scarce.
To compare clinical outcomes between patients with ICAD and those without ICAD following mechanical thrombectomy (MT).
We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center, and compared in-hospital mortality, 90-day mortality, favorable functional outcome at 90 days, and symptomatic intracranial hemorrhage (ICH) using chi-squared tests and multivariate logistic regression analyses. We defined ICAD as observable plaque at occlusion site post-thrombectomy.
Among 215 patients (mean age 67.1 ± 16.0 years; 60.5% female; 83.6% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.081). In-hospital and 90-day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0-2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in-hospital mortality (OR=4.1, 95% CI 1.7-9.7), 90-day mortality (OR=3.7, 95% CI 1.6-8.6), and poor functional outcome at 90 days (OR=5.5, 95% CI 1.6-19.4).
Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT.
颅内动脉粥样硬化性疾病（ICAD）导致的大血管闭塞（LVO）管理的数据很少。
比较机械血栓切除术（MT）后因 ICAD 和非 ICAD 导致 LVO 的患者的临床结局。
我们对在一家大型学术综合卒中中心接受 MT 治疗的 LVO 连续患者进行了回顾性分析，并使用卡方检验和多变量逻辑回归分析比较了住院死亡率、90 天死亡率、90 天的良好功能结局和症状性颅内出血（ICH）。我们将 ICAD 定义为血栓切除术后闭塞部位可见斑块。
在 215 名患者（平均年龄 67.1±16.0 岁；60.5%为女性；83.6%为黑人，NIHSS 中位数为 16）中，38 名患者（17.7%）存在 ICAD。ICAD 患者中更常见糖尿病和血脂异常（57.9%比 38.4%，p=0.027 和 29.0%比 14.7%，p=0.035）。但 ICAD 患者实现了更高的充分再灌注（TICI≥2b）（84.2%比 94.4%，p=0.031），但症状性 ICH 也较少（0%比 9.0%，p=0.081）。住院死亡率和 90 天死亡率更高（36.8%比 15.8%，p=0.003 和 52.6%比 26.6%，p=0.002），90 天的良好功能结局（mRS 0-2）更少见（7.9%比 33.9%，p=0.001）。在调整预后变量后，ICAD 与住院死亡率（OR=4.1，95%CI 1.7-9.7）、90 天死亡率（OR=3.7，95%CI 1.6-8.6）和 90 天不良功能结局（OR=5.5，95%CI 1.6-19.4）独立相关。
在以非裔美国人为主的队列中，症状性 ICAD 与 LVO 接受 MT 治疗的患者住院死亡率和 90 天不良功能结局的几率增加相关。
