Qiu Kai, Hang Yu, Lv Penghua, Liu Ying, Li Mingchao, Zhao Liandong, Zhai Qijin, Chen Jinan, Jia Zhenyu, Cao Yuezhou, Zhao Linbo, Shi Haibin, Liu Sheng
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Department of Interventional Radiology, Clinical Medical Collage of Yangzhou University, Northern Jiangsu People'S Hospital, Yangzhou, 225000, China.
Transl Stroke Res. 2025 Mar 4. doi: 10.1007/s12975-025-01337-1.
To evaluate whether endovascular thrombectomy (EVT) combined with best medical management (BMM) is more effective than BMM alone in treating mild stroke patients (National Institutes of Health Stroke Scale score < 6) with large vessel occlusion (LVO). A multicentric retrospective cohort of patients with LVO and mild stroke within 24 h from symptom onset was included. Patients were divided into the primary EVT (EVT) group and the primary BMM (BMM) group according to the treatment strategy. Functional outcomes were compared after propensity score matching. Additionally, adjusted logistic regression analysis was used to assess the association between treatment strategy and functional outcomes. Finally, 419 patients were included, with 137 receiving EVT and 282 receiving BMM. After propensity score matching (EVT, 126 vs. BMM 126), baseline characteristics were balanced between the two groups. No significant difference was observed in 3-month functional independence (modified Rankin Scale [mRS] 0-2, 78.6% vs. 76.2%. In the overall cohort, EVT was not associated with functional independence (adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.43-1.47). However, patients in the EVT group were more likely to experience symptomatic intracranial hemorrhage (aOR, 1.27; 95% CI, 1.05-1.89). Subgroup analysis revealed that EVT was significantly associated with functional independence in vertebrobasilar occlusion subgroup (aOR, 1.78; 95% CI, 1.20-3.90). Our findings did not support the systematic use of EVT for mild stroke with LVO, except in cases of vertebrobasilar occlusion, which may represent a subgroup where EVT could provide significant benefits.
为评估血管内血栓切除术（EVT）联合最佳药物治疗（BMM）在治疗伴有大血管闭塞（LVO）的轻度卒中患者（美国国立卫生研究院卒中量表评分<6）方面是否比单纯BMM更有效。纳入了症状发作后24小时内患有LVO和轻度卒中的多中心回顾性队列患者。根据治疗策略将患者分为主要EVT（EVT）组和主要BMM（BMM）组。在倾向评分匹配后比较功能结局。此外，使用校正逻辑回归分析来评估治疗策略与功能结局之间的关联。最终，纳入了419例患者，其中137例接受了EVT，282例接受了BMM。在倾向评分匹配后（EVT，126例 vs. BMM 126例），两组之间的基线特征达到平衡。在3个月时的功能独立性方面未观察到显著差异（改良Rankin量表[mRS] 0 - 2，分别为78.6% vs. 76.2%）。在整个队列中，EVT与功能独立性无关（校正优势比[aOR]，0.87；95%置信区间[CI]，0.43 - 1.47）。然而，EVT组的患者更有可能发生有症状的颅内出血（aOR，1.27；95% CI，1.05 - 1.89）。亚组分析显示，在椎基底动脉闭塞亚组中，EVT与功能独立性显著相关（aOR，1.78；95% CI，1.20 - 3.90）。我们的研究结果不支持对伴有LVO的轻度卒中系统性地使用EVT，除了椎基底动脉闭塞的情况，这可能代表一个EVT能带来显著益处的亚组。
