Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Department of NEUROFARBA, Neuroscience Section, University of Florence, Florene, Italy.
Neurol Sci. 2024 Nov;45(11):5327-5336. doi: 10.1007/s10072-024-07638-x. Epub 2024 Jun 18.
Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO.
We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853).
After adjustment for unbalanced pre-procedure variables (year 2015-2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0-2 (OR 0.415, 95% CI 0.268-0.644) and with higher risk of death (OR 2.813, 95% CI 2.080-3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0-2 (OR 0.444, 95% CI 0.304-0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993-4.429) remained significant.
MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months.
机械取栓（MT）已被证明对前串联闭塞（a-TO）的急性缺血性脑卒中患者有益。然而，对于后串联闭塞（p-TO）的脑卒中患者，MT 的有效性知之甚少。我们旨在比较 p-TO 与 a-TO 的急性缺血性脑卒中患者在最后已知健康时间 24 小时内进行 MT 的效果。
我们对前瞻性收集的意大利血管内治疗急性脑卒中登记研究（IRETAS）中在最后已知健康时间 24 小时内接受 MT 治疗的急性缺血性脑卒中伴 p-TO（n=275）或 a-TO（n=1853）患者的数据进行了队列研究。
在调整了不平衡的术前变量（2015-2021 年、年龄、性别、NIHSS 评分、ASPECTS 和穿刺腹股沟时间分层）和预先设定的预测因子即卒中前 mRS 评分后，p-TO 与较低的 mRS 评分 0-2 概率（OR 0.415，95%CI 0.268-0.644）和 3 个月时死亡风险增加（OR 2.813，95%CI 2.080-3.805）显著相关。在调整了不平衡的手术和术后变量（IVT、全身麻醉、TICI 3 和 24 小时 HT）和预先设定的预测因子即卒中前 mRS 评分后，p-TO 与较低的 mRS 评分 0-2 概率（OR 0.444，95%CI 0.304-0.649）和 p-TO 与死亡风险增加（OR 2.971，95%CI 1.993-4.429）之间的关联仍然显著。
在最后已知健康时间 24 小时内对 p-TO 与 a-TO 的缺血性脑卒中患者进行 MT 与 3 个月时的不良结局相关。
