Department of Neuroradiology, CHU Marseille La Timone, Marseille, France.
Department of Neuroradiology, CHU Marseille La Timone, Marseille, France.
Clin Neurol Neurosurg. 2024 Sep;244:108452. doi: 10.1016/j.clineuro.2024.108452. Epub 2024 Jul 14.
Recently, four randomized controlled trials (RCTs) have demonstrated the benefits of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) and a large ischemic core at baseline (LIC). The purpose of this study was to investigate the features influencing the clinical outcome and the benefits of mechanical thrombectomy in this subgroup.
We conducted a multicenter retrospective aggregate cohort study of patients with AIS-LVO and a LIC, assessed with quantitative core volume measures, treated with MT between 2012 and 2019. The data were queried through four registries, including patients with core volumes ≥50cc. Multivariable logistic regression models were employed to determine factors independently associated with clinical outcomes in patients with successful recanalization (modified-Thrombolysis-in-Cerebral-Infarction-score, mTICI=2b-3) and unsuccessful recanalization group (mTICI=0-2a). The primary endpoint was a favorable functional outcome at day-90, defined as a modified Rankin scale (mRS) of 0-3, accounting for the inherent severity of AIS with baseline LIC. Secondary outcomes included functional independence (mRS 0-2) at day-90, mortality, and symptomatic Intracranial Hemorrhage (sICH).
A total of 460 patients were included (mean age 66±14.2 years; 39.6 % females). The mean baseline NIHSS was 20±5.2, and the core volume was 103.2±54.6 ml. Overall, 39.8 % (183/460) of patients achieved a favorable outcome at day-90 (mRS 0-3). Successful recanalization was significantly associated with a more frequent favorable outcome (aOR, 4.79; 95 %CI, 2.73-8.38; P<0.01) and functional independence (P<0.01). This benefit remained significant in older patients and in patients with cores above 100cc. At 90 days, 147/460 patients (32 %) were deceased, with successful recanalization significantly associated with less frequent mortality (OR, 0.34; 95 %CI, 0.22-0.53; P<0.01). The rate of sICH was 17.4 % and did not differ significantly between groups.
In this large, pooled-cohort study of AIS-LVO patients with infarct cores over 50cc at baseline, we demonstrated that successful recanalization was associated with a better functional outcome, lower mortality, and similar rates of symptomatic intracranial hemorrhage for a wide spectrum of patients.
最近，四项随机对照试验（RCT）表明，机械血栓切除术（MT）对急性缺血性卒中（AIS）患者有益，这些患者的基线（LIC）有前大血管闭塞（LVO）和大缺血核心。本研究的目的是探讨影响临床结局和机械血栓切除术在此亚组中获益的特征。
我们对 2012 年至 2019 年间接受 MT 治疗的 AIS-LVO 和 LIC 患者进行了多中心回顾性汇总队列研究，通过定量核心体积测量进行评估。通过四个登记处查询数据，包括核心体积≥50cc 的患者。采用多变量逻辑回归模型确定成功再通（改良脑梗死溶栓评分，mTICI=2b-3）和未成功再通组（mTICI=0-2a）患者的临床结局独立相关因素。主要终点为第 90 天的良好功能结局，定义为改良 Rankin 量表（mRS）0-3，考虑到基线 LIC 固有 AIS 的严重程度。次要结局包括第 90 天的功能独立性（mRS 0-2）、死亡率和症状性颅内出血（sICH）。
共纳入 460 例患者（平均年龄 66±14.2 岁；39.6%为女性）。基线 NIHSS 平均为 20±5.2，核心体积为 103.2±54.6ml。总体而言，460 例患者中有 39.8%（183/460）在第 90 天达到良好结局（mRS 0-3）。成功再通与更频繁的良好结局（优势比，4.79；95%CI，2.73-8.38；P<0.01）和功能独立性（P<0.01）显著相关。这种益处在老年患者和核心体积超过 100cc 的患者中仍然显著。90 天时，460 例患者中有 147/460 例（32%）死亡，成功再通与死亡率显著降低相关（OR，0.34；95%CI，0.22-0.53；P<0.01）。症状性颅内出血发生率为 17.4%，两组间无显著差异。
在这项对基线时梗死核心超过 50cc 的 AIS-LVO 患者进行的大型汇总队列研究中，我们证明成功再通与更好的功能结局、更低的死亡率相关，对于广泛的患者，症状性颅内出血的发生率相似。
