颅内动脉粥样硬化性疾病导致的急性卒中血管内治疗后的早期神经学改变。
Early neurological changes following endovascular therapy for acute stroke due to intracranial atherosclerotic disease.
机构信息
Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan; Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
出版信息
J Neurol Sci. 2024 May 15;460:122978. doi: 10.1016/j.jns.2024.122978. Epub 2024 Mar 26.
BACKGROUND
Endovascular therapy (EVT) reduces functional disability in patients with acute large vessel occlusion (LVO). However, the early neurological change after EVT may be limited in patients with intracranial atherosclerotic disease (ICAD).
METHODS
We analyzed the Japanese Registry of NeuroEndovascular Therapy (JR-NET) 4 which was a retrospective, nationwide, multicenter registry of patients with LVO between 2015 and 2019. We compared the early neurological change, efficacy and safety of EVT for acute LVO in ICAD and other etiologies. The primary outcome was NIHSS improvement ≥10 points, and secondary outcome were NIHSS worsening ≥4 points 7 days after EVT, effective reperfusion rate, 30-day functional outcomes, and safety outcomes.
RESULTS
Among the 6710 enrolled patients, 610 (9.1%) had ICAD. The ICAD group was younger (mean 72.0 vs. 75.8 years) and predominantly male (63.4% vs. 56.0%), had lower NIHSS scores before EVT (median 16 vs. 18), and underwent percutaneous transluminal angioplasty and stenting more frequently (43.0% vs. 4.4%, 12.3% vs. 4.4%). In the ICAD group, NIHSS improvement was significantly lower (adjusted odds ratio (aOR) [95% confidence interval (95%CI)] 0.52 [0.41-0.65]), NIHSS worsening was significantly higher (aOR [95%CI] 1.76 [1.31-2.34]), and effective reperfusion was significantly lower (aOR [95%CI] 0.47 [0.36-0.60]). Fewer patients with ICAD had modified Rankin scale 0-2 at 30 days (aOR [95%CI] 0.60 [0.47-0.77]). The risk of acute reocclusion was more prominent in the ICAD group (aOR [95%CI] 4.03 [1.98-8.21]).
CONCLUSIONS
Improvement in neurological severity after EVT was lower in patients with LVO and ICAD.
背景
血管内治疗（EVT）可降低急性大血管闭塞（LVO）患者的功能残疾程度。然而，在颅内动脉粥样硬化性疾病（ICAD）患者中，EVT 后的早期神经学变化可能有限。
方法
我们分析了 2015 年至 2019 年期间在日本神经血管治疗登记处（JR-NET）4 中接受 LVO 治疗的患者，该登记处是一项回顾性的、全国性的、多中心登记处。我们比较了 EVT 治疗急性 LVO 后 ICAD 和其他病因的早期神经学变化、疗效和安全性。主要结局是 NIHSS 改善≥10 分，次要结局是 EVT 后 7 天 NIHSS 恶化≥4 分、有效再灌注率、30 天功能结局和安全性结局。
结果
在 6710 名入组患者中，610 名（9.1%）患有 ICAD。ICAD 组更年轻（平均 72.0 岁 vs. 75.8 岁），男性为主（63.4% vs. 56.0%），EVT 前 NIHSS 评分较低（中位数 16 分 vs. 18 分），更常接受经皮腔内血管成形术和支架置入术（43.0% vs. 4.4%，12.3% vs. 4.4%）。在 ICAD 组，NIHSS 改善明显较低（校正优势比[aOR] [95%置信区间（95%CI）] 0.52 [0.41-0.65]），NIHSS 恶化明显较高（aOR [95%CI] 1.76 [1.31-2.34]），有效再灌注明显较低（aOR [95%CI] 0.47 [0.36-0.60]）。30 天时，ICAD 患者改良 Rankin 量表 0-2 分的比例较低（aOR [95%CI] 0.60 [0.47-0.77]）。ICAD 组急性再闭塞的风险更为突出（aOR [95%CI] 4.03 [1.98-8.21]）。
结论
LVO 合并 ICAD 患者 EVT 后神经严重程度改善较低。
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