Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
J Neurointerv Surg. 2024 Aug 14;16(9):884-891. doi: 10.1136/jnis-2023-020670.
Atherothrombotic stroke-related large vessel occlusion (AT-LVO) is caused by two etiologies, the intracranial artery occlusion due to in situ occlusion (intracranial group) or due to embolism from cervical carotid occlusion or stenosis (tandem group). The prognosis and reocclusion rate of each etiology after endovascular therapy (EVT) is unclear.
We conducted a historical multicenter registry study at 51 Japanese centers to compare the prognoses of AT-LVO between two etiologies. The primary outcome was the incidence of recurrent ischemic stroke or reocclusion of the treated vessels within 90 days after EVT. Each of the primary outcome means the incidence of recurrent ischemic stroke and reocclusion of the treated vessels within 90 days after EVT.
We analyzed 582 patients (338 in the intracranial group and 244 in the tandem group). Patients in the intracranial group were younger (mean 71.9 vs 74.5, p=0.003), more of them were female and fewer of them were current smokers than those in the tandem group. In the tandem group, the patients' National Institutes of Health Stroke Scale score on admission was higher (13 vs 15, p=0.006), onset to puncture time was shorter (299 [145-631] vs 232 [144-459] minutes, p=0.03) and Alberta Stroke Program Early CT Score (ASPECTS) was lower (8 [7-9] vs 8 [6-9], p=0.0002). The primary outcome was higher in the intracranial group (22.5% vs 8.2%, p<0.0001). However, any ICH and death were not significantly different in the two groups.
The incidence of recurrent ischemic stroke or reocclusion after EVT for AT-LVO was higher in the intracranial group.
动脉粥样硬化血栓性脑梗死相关的大血管闭塞（AT-LVO）由两种病因引起，一种是原位闭塞引起的颅内动脉闭塞（颅内组），另一种是由于颈内颈动脉闭塞或狭窄引起的栓塞（串联组）。血管内治疗（EVT）后两种病因的预后和再闭塞率尚不清楚。
我们在日本 51 个中心进行了一项历史上的多中心登记研究，以比较两种病因的 AT-LVO 预后。主要结局是 EVT 后 90 天内复发性缺血性卒中和治疗血管再闭塞的发生率。每个主要结局是指 EVT 后 90 天内复发性缺血性卒中和治疗血管再闭塞的发生率。
我们分析了 582 例患者（颅内组 338 例，串联组 244 例）。颅内组患者年龄较小（平均 71.9 岁比 74.5 岁，p=0.003），女性较多，当前吸烟者较少。在串联组中，患者入院时 NIHSS 评分较高（13 分比 15 分，p=0.006），发病至穿刺时间较短（299[145-631]分钟比 232[144-459]分钟，p=0.03），ASPECTS 评分较低（8[7-9]分比 8[6-9]分，p=0.0002）。颅内组的主要结局较高（22.5%比 8.2%，p<0.0001）。然而，两组的任何 ICH 和死亡率均无显著差异。
EVT 治疗 AT-LVO 后，颅内组复发性缺血性卒中和再闭塞的发生率较高。
