Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands.
Eur Stroke J. 2024 Jun;9(2):312-319. doi: 10.1177/23969873231216811. Epub 2023 Dec 15.
Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT).
We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality.
Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57).
MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.
对于接受血管内治疗 (EVT) 的大血管闭塞性卒中患者，多血管闭塞 (MVO) 的影响知之甚少。
我们报告了 MR CLEAN 登记处的数据：这是一项对荷兰所有接受 EVT 的卒中患者进行的前瞻性、观察性研究（2014 年 3 月至 2017 年 11 月）。我们纳入了前循环颅内靶血管闭塞的患者。MVO 的定义为 MCA 闭塞（M1/M2）或颅内 ICA/ICA-T 闭塞，同时在基线 CTA 上证实存在第二处 ACA 或 PCA 区域的闭塞。为了比较结果，我们使用包含潜在混杂因素的逻辑回归模型进行了 10:1 的倾向评分匹配分析。结局指标包括 90 天的功能结局（改良 Rankin 量表，mRS）和死亡率。
在 2946 例纳入患者中，71 例（2.4%）存在 MVO（87%并发 ACA 闭塞，10%PCA 闭塞，3% ⩾3 处闭塞）。这些患者与 71 例非 MVO 患者相匹配。匹配前，MVO 患者的基线 NIHSS 更高（中位数 18 分比 16 分，=0.001），侧支循环状态更差（无侧支循环：17%比 6%，<0.001）。匹配后，MVO 患者在 90 天时的功能结局更差（中位数 mRS 5 分比 3 分，cOR 0.39；95%CI 0.25-0.62）。MVO 患者的死亡率更高（46%比 27%，OR 2.11，95%CI 1.24-3.57）。
在接受 EVT 的 LVO 卒中患者中，基线影像学上的 MVOs 并不常见，但与不良的功能结局相关。
