Wang Feng, Xu Xiaoping, Zheng Lin, Zhong Jiawei, Wang En, Liu Yang, Ke Shaofa
Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.
Department of Neurology, Saarland University, Homburg, Germany.
Front Neurol. 2024 Nov 29;15:1489296. doi: 10.3389/fneur.2024.1489296. eCollection 2024.
Perioperative ischemic stroke is a rare but devastating complication. Mechanical thrombectomy is a promising therapeutic method, but very little data is available on its efficacy and safety. This study aims to answer this question by comparing the clinical outcomes of perioperative and community-onset stroke patients after endovascular therapy.
A retrospective cohort study was conducted on a total of 35 perioperative and 584 community-onset acute ischemic stroke patients who underwent endovascular thrombectomy at our hospital over the past 3.5 years. The recanalization rate, clinical recovery and cerebral hemorrhage within 90 days after therapy were compared between these two patient groups.
Endovascular thrombectomy provided perioperative and community-onset ischemic stroke patients with comparable rates of successful reperfusion (mTICI ≥2b grade) (97.1% vs. 97.3%; = 0. 967) and favorable functional recovery (mRS ≤ 2) (51.4% vs. 43.3%, = 0.348), with no increase in severe intracranial hemorrhage (0% vs. 2.6 and 1.0%, for hematoma ≥30% of infarcted tissue and intraventricular hemorrhage, respectively) within 90 days. In addition, perioperative stroke patients had higher prevalence of atrial fibrillation (42.9% vs. 26.7%; = 0.038) and intracranial cerebral artery stenosis without clear embolism (17.1% vs. 3.8%; < 0.001) than community-onset stroke patients.
Endovascular thrombectomy is an effective and safe therapeutic approach for patients with perioperative ischemic stroke, although the results need to be validated by further studies with larger populations. Atrial fibrillation and large artery stenosis may contribute to the pathogenesis of perioperative ischemic stroke.
围手术期缺血性卒中是一种罕见但具有毁灭性的并发症。机械取栓术是一种有前景的治疗方法，但关于其疗效和安全性的数据非常少。本研究旨在通过比较血管内治疗后围手术期和社区发病卒中患者的临床结局来回答这个问题。
对过去3.5年在我院接受血管内取栓术的35例围手术期和584例社区发病急性缺血性卒中患者进行了一项回顾性队列研究。比较这两组患者治疗后90天内的再通率、临床恢复情况和脑出血情况。
血管内取栓术为围手术期和社区发病缺血性卒中患者提供了相似的成功再灌注率（改良脑梗死溶栓分级[mTICI]≥2b级）（97.1%对97.3%；P = 0.967）和良好的功能恢复率（改良Rankin量表[mRS]≤2）（51.4%对43.3%，P = 0.348），90天内严重颅内出血无增加（分别为血肿≥梗死组织的30%和脑室内出血，0%对2.6%和1.0%）。此外，围手术期卒中患者房颤患病率（42.9%对26.7%；P = 0.038）和无明确栓塞的颅内脑动脉狭窄患病率（17.1%对3.8%；P < 0.001）高于社区发病卒中患者。
血管内取栓术是治疗围手术期缺血性卒中患者的一种有效且安全的治疗方法，尽管结果需要通过更大规模人群的进一步研究来验证。房颤和大动脉狭窄可能是围手术期缺血性卒中发病机制的因素。
