Matsukawa Hidetoshi, Uchida Kazutaka, Elawady Sameh Samir, Cunningham Conor, Sowlat Mohammad-Mahdi, Maier Ilko, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Quintero, Rai Ansaar, Starke Robert M, Psychogios Marios-Nikos, Samaniego Edgar A, Arthur Adam S, Yoshimura Shinichi, Cuellar-Saenz Hugo, Grossberg Jonathan A, Alawieh Ali, Romano Daniele G, Tanweer Omar, Mascitelli Justin, Fragata Isabel, Polifka Adam, Osbun Joshua, Crosa Roberto, Matouk Charles, Park Min S, Levitt Michael R, Brinjikji Waleed, Moss Mark, Williamson Richard, Navia Pedro, Kan Peter, De Leacy Reade, Chowdhry Shakeel, Ezzeldin Mohamad, Spiotta Alejandro M
1Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina.
Departments of2Neurosurgery and.
J Neurosurg. 2025 Feb 7;143(1):266-273. doi: 10.3171/2024.10.JNS24888. Print 2025 Jul 1.
The definitive influence of prestroke disability on outcomes in patients with a low Alberta Stroke Program Early CT Score (ASPECTS) treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains unknown. This study aimed to investigate the impact of prestroke disability on outcomes in this specific population.
Data from 32 international centers for AIS-LVO patients with a low ASPECTS who underwent EVT between January 2013 and December 2022 were analyzed retrospectively. Low ASPECTS and prestroke disability were defined as ASPECTS values of 2-5 and prestroke modified Rankin Scale (mRS) score ≥ 2. The primary outcome was a return to the prestroke mRS score at 90 days. Secondary outcomes were independent ambulation (mRS scores of 0-3) or a return to the prestroke mRS score at 90 days, good functional outcome (mRS scores of 0-2) or a return to the prestroke mRS score at 90 days, successful recanalization, and 90-day mortality. Safety outcomes were any intracranial hemorrhage or symptomatic intracranial hemorrhage. A symptomatic intracranial hemorrhage was defined as an intracranial hemorrhage with an associated worsening of ≥ 4 points in the National Institutes of Health Stroke Scale score. Outcomes were compared between patients with and without prestroke disability.
Of 293 patients, 50 (17.1%) had a prestroke disability. Of 50 patients, 20 (40.0%), 24 (48.0%), and 6 (12.0%) had prestroke mRS scores of 2, 3, and 4, respectively. The primary outcome showed no significant difference between the two groups. Compared with patients without prestroke disability, those with prestroke disability had a significantly smaller proportion of independent ambulation or return to prestroke mRS score (adjusted OR 0.13, 95% CI 0.03-0.53) and good functional outcome or return to prestroke mRS score (adjusted OR 0.21, 95% CI 0.05-0.91). Other secondary and safety outcomes showed no significant difference between the two groups.
The present study indicated that prestroke disability was not associated with a return to the prestroke mRS score at 90 days or intracranial hemorrhage. Physicians should not routinely exclude AIS-LVO patients with a low ASPECTS who have prestroke disability from EVT based on prestroke disability alone.
对于因大血管闭塞（LVO）导致急性缺血性卒中（AIS）且阿尔伯塔卒中项目早期CT评分（ASPECTS）较低的患者，卒中前残疾对其血管内血栓切除术（EVT）治疗结局的决定性影响尚不清楚。本研究旨在调查卒中前残疾对这一特定人群结局的影响。
回顾性分析了2013年1月至2022年12月期间在32个国际中心接受EVT治疗的AIS-LVO且ASPECTS较低患者的数据。低ASPECTS和卒中前残疾分别定义为ASPECTS值为2-5以及卒中前改良Rankin量表（mRS）评分≥2。主要结局是90天时恢复到卒中前mRS评分。次要结局是独立行走（mRS评分为0-3）或90天时恢复到卒中前mRS评分、良好功能结局（mRS评分为0-2）或90天时恢复到卒中前mRS评分、成功再通以及90天死亡率。安全性结局是任何颅内出血或有症状颅内出血。有症状颅内出血定义为伴有美国国立卫生研究院卒中量表评分恶化≥4分的颅内出血。比较了有和没有卒中前残疾患者的结局。
在293例患者中，50例（17.1%）有卒中前残疾。在50例患者中，分别有20例（40.0%）、24例（48.0%）和6例（12.0%）的卒中前mRS评分为2、3和4。主要结局在两组之间无显著差异。与没有卒中前残疾的患者相比，有卒中前残疾的患者独立行走或恢复到卒中前mRS评分的比例显著更小（校正OR 0.13，95%CI 0.03-0.53）以及良好功能结局或恢复到卒中前mRS评分的比例显著更小（校正OR 0.21，95%CI 0.05-0.91）。其他次要和安全性结局在两组之间无显著差异。
本研究表明，卒中前残疾与90天时恢复到卒中前mRS评分或颅内出血无关。医生不应仅基于卒中前残疾就常规排除ASPECTS较低且有卒中前残疾的AIS-LVO患者接受EVT治疗。
