Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay.
World Neurosurg. 2024 Sep;189:e435-e441. doi: 10.1016/j.wneu.2024.06.082. Epub 2024 Jun 20.
The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) caused by anterior circulation large vessel occlusion (LVO) remains unknown. The present study aimed to evaluate the influence of OPT on 90-day mortality in anterior circulation AIS-LVO patients who underwent EVT.
Data from 33 international centers were retrospectively analyzed. The receiver operating characteristic curve analysis was used to identify a cutoff for OPT. A propensity score-matched analysis was performed. The primary outcome was 90-day mortality (modified Rankin Scale [mRS] 6). Secondary outcomes included mortality at discharge, 90-day good outcome (mRS 0-2), 90-day poor outcome (mRS 5-6), successful recanalization (defined as postprocedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage.
A total of 2842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. Of these 378 patients had OPT <180 min and 378 patients had OPT ≥180 min in the propensity score-matched cohort (n = 756). Patients with OPT <180 min were less likely to have 90-day mortality (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.51-0.96) and poor outcome (OR 0.71, 95% CI 0.53-0.96), and more likely to have 90-day good outcome (OR 1.55, 95% CI 1.16-2.08). Other outcomes showed no significant differences.
This study showed that OPT <180 min was less related to 90-day mortality and poor outcome, and more to 90-day good outcome in AIS-LVO patients who underwent EVT.
急性缺血性卒中（AIS）患者前循环大血管闭塞（LVO）血管内血栓切除术（EVT）后，发病至动脉穿刺时间（OPT）对 90 天死亡率的明确影响尚不清楚。本研究旨在评估 OPT 对接受 EVT 的前循环 AIS-LVO 患者 90 天死亡率的影响。
回顾性分析来自 33 个国际中心的数据。使用受试者工作特征曲线分析确定 OPT 的截止值。进行倾向评分匹配分析。主要结局为 90 天死亡率（改良 Rankin 量表[mRS]6）。次要结局包括出院时死亡率、90 天良好结局（mRS 0-2）、90 天不良结局（mRS 5-6）、成功再通（定义为后处理改良脑梗死溶栓分级≥2b）和颅内出血。
共纳入 2842 例接受 EVT 的 AIS-LVO 患者。90 天死亡率的 OPT 截止值为 180 分钟。在倾向评分匹配队列中，378 例患者的 OPT<180 分钟，378 例患者的 OPT≥180 分钟（n=756）。OPT<180 分钟的患者 90 天死亡率（比值比[OR]0.70，95%置信区间[CI]0.51-0.96）和不良结局（OR 0.71，95% CI 0.53-0.96）的可能性较小，90 天良好结局（OR 1.55，95% CI 1.16-2.08）的可能性较大。其他结局无显著差异。
本研究表明，EVT 后 AIS-LVO 患者 OPT<180 分钟与 90 天死亡率和不良结局的相关性较低，与 90 天良好结局的相关性较高。
