Baek Jang-Hyun, Heo Ji Hoe, Nam Hyo Suk, Kim Byung Moon, Kim Dong Joon, Kim Young Dae
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea.
Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2023 Oct 18;12(20):6596. doi: 10.3390/jcm12206596.
Clinical benefit can be time-dependent even after first-pass recanalization (FPR) in endovascular treatment of acute stroke. This study aimed to evaluate the association between favorable outcome and FPR under a specific time frame. Patients who underwent mechanical thrombectomy were retrospectively reviewed. Recanalization status was categorized into four groups based on FPR and dichotomized time from groin puncture to recanalization (P-to-R time). Favorable outcomes were compared between groups. A total of 458 patients were included. As the cutoff of P-to-R time for favorable outcome was 30 min, recanalization status was categorized into FPR (+) with a P-to-R time ≤ 30 min (Group 1), FPR (-) with a P-to-R time ≤ 30 min (Group 2), FPR (+) with a P-to-R time > 30 min (Group 3), and FPR (-) with a P-to-R time > 30 min (Group 4). Favorable outcomes in Group 3 (37.5%) were significantly less frequent than those in Group 1 (60.4%, = 0.029) and Group 2 (59.5%, = 0.033) but were not significantly different from those in Group 4 (35.7%, = 0.903). Compared to Group 1, Group 3 (adjusted odds ratio, 0.30 [95% confidence interval, 0.12-0.76]; = 0.011) and Group 4 (0.25 [0.14-0.48]; < 0.001) were adversely associated with favorable outcomes. FPR was associated with functional outcome in a time-dependent manner. Even for patients who have achieved FPR, their functional outcome might not be favorable if the P-to-R time is >30 min.
在急性卒中血管内治疗中，即使首次通过再通（FPR）后，临床获益也可能具有时间依赖性。本研究旨在评估在特定时间框架内良好预后与FPR之间的关联。对接受机械取栓术的患者进行回顾性分析。根据FPR和从腹股沟穿刺到再通的二分时间（P-to-R时间），将再通状态分为四组。比较各组的良好预后情况。共纳入458例患者。由于良好预后的P-to-R时间截止值为30分钟，再通状态分为P-to-R时间≤30分钟的FPR（+）（第1组）、P-to-R时间≤30分钟的FPR（-）（第2组）、P-to-R时间>30分钟的FPR（+）（第3组）和P-to-R时间>30分钟的FPR（-）（第4组）。第3组的良好预后（37.5%）明显低于第1组（60.4%，P = 0.029）和第2组（59.5%，P = 0.033），但与第4组（35.7%，P = 0.903）无显著差异。与第1组相比，第3组（调整后的优势比，0.30[95%置信区间，0.12 - 0.76]；P = 0.011）和第4组（0.25[0.14 - 0.48]；P < 0.001）与良好预后呈负相关。FPR与功能结局呈时间依赖性关联。即使对于已实现FPR的患者，如果P-to-R时间>30分钟，其功能结局可能也不理想。
