Lu Da, Raynald Raynald, Sun Dapeng, Zheng Na, Zhang Bohao, Luo Leilei, Wang Sifei, Pan Sihu, Dou Yuchao, Wang Mengxing, Pan Yuesong, Huo Xiaochuan, Miao Zhongrong, Wei Ming
Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Stroke Vasc Neurol. 2024 Sep 17;10(3). doi: 10.1136/svn-2024-003115.
Our study aims to examine the value of endovascular therapy (EVT) and its comparison to medical management (MM) in ischaemic stroke patients accompanied by large artery atherosclerosis (LAA) and non-LAA METHODS: modified Rankin scale score (mRS) was evaluated at 90 days post the stroke attack and was considered as the primary outcome. Other outcomes measured in this study included score changes of 0-2 and 0-3 on the mRS. The occurrence of symptomatic intracranial haemorrhage at 24 hours after EVT was also measured as a safety endpoint. Logistic regression analysis was used to determine the associations.
In the LAA group, no significant difference in mRS at 90-day (median IQR 3 (2-5) vs 4 (3-4), 95% CI 0.53 to 2.00, p=0.924), mRS 0-2 and mRS 0-3 was observed between EVT and MM groups. However, in the non-LAA group, patients who underwent EVT had lower 90-day mRS scores (4 (2-5) vs 4 (3-5), generalised OR 1.47, 95% CI 1.14 to 1.88, p<0.001). No interaction effect on the primary outcomes between treatment options and aetiology. More intracranial haemorrhage events within 48 hours were identified in the EVT group for both LAA and non-LAA cohorts (LAA: 40.98% vs 9.62%, relative risk (RR) 4.26, 95% CI 1.76 to 10.34, p<0.001; non-LAA, 52.07% vs 19.65%, RR 2.65, 95% CI 1.90 to 3.70, respectively).
For large infarcts, EVT may be more effective than MM for patients with non-LAA aetiology, but not for those with LAA stroke. As no interaction effect was found, the benefit of EVT compared with MM did not vary by stroke subtypes.
本研究旨在探讨血管内治疗（EVT）在伴有大动脉粥样硬化（LAA）和非LAA的缺血性脑卒中患者中的价值及其与药物治疗（MM）的比较。方法：在脑卒中发作后90天评估改良Rankin量表评分（mRS），并将其作为主要结局。本研究测量的其他结局包括mRS上0至2分和0至3分的评分变化。还将EVT后24小时内症状性颅内出血的发生情况作为安全性终点进行测量。采用逻辑回归分析来确定相关性。
在LAA组中，EVT组和MM组在90天时的mRS（中位数IQR 3（2 - 5）对4（3 - 4），95%CI 0.53至2.00，p = 0.924）、mRS 0 - 2和mRS 0 - 3方面未观察到显著差异。然而，在非LAA组中，接受EVT的患者90天时的mRS评分较低（4（2 - 5）对4（3 - 5），广义OR 1.47，95%CI 1.14至1.88，p < 0.001）。治疗方案和病因之间对主要结局没有交互作用。在LAA和非LAA队列的EVT组中，48小时内发现更多颅内出血事件（LAA：40.98%对9.62%，相对风险（RR）4.26，95%CI 1.76至10.34，p < 0.001；非LAA，52.07%对19.65%，RR 2.65，95%CI分别为1.90至3.70）。
对于大面积梗死，EVT对非LAA病因的患者可能比MM更有效，但对LAA脑卒中患者则不然。由于未发现交互作用，与MM相比，EVT的益处不因卒中亚型而异。
