卒中前残疾患者的机械取栓术：来自意大利血管内卒中登记处的数据。
Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry.
作者信息
Naldi Andrea, D'Agata Federico, Pracucci Giovanni, Saia Valentina, Cavallo Roberto, Castellano Davide, Sallustio Fabrizio, Casetta Ilaria, Fainardi Enrico, Da Ros Valerio, Maestrini Ilaria, Vinci Sergio Lucio, La Spina Paolino, Limbucci Nicola, Nencini Patrizia, Lafe Elvis, Longoni Marco, Bracco Sandra, Tassi Rossana, Vallone Stefano, Bigliardi Guido, Cerrato Paolo, Castellan Lucio, Del Sette Massimo, Menozzi Roberto, Pezzini Alessandro, Merolla Stefano, Forlivesi Stefano, Nappini Sergio, Loizzo Nicola Davide, Saletti Andrea, Azzini Cristiano, Lazzarotti Guido Andrea, Giannini Nicola, Romano Daniele Giuseppe, Napoletano Rosa, Burdi Nicola, Boero Giovanni, Comai Alessio, Dall'Ora Elisa, Cavasin Nicola, Critelli Adriana, Plebani Mauro, Cappellari Manuel, Zimatore Domenico Sergio, Petruzzellis Marco, Biraschi Francesco, Nicolini Ettore, Sanna Antioco, Tassinari Tiziana, Puglielli Edoardo, Casalena Alfonsina, Gallesio Ivan, Ferrandi Delfina, Filauri Pietro, Sacco Simona, Paladini Adriana, Rizzo Annalisa, Besana Michele, Giossi Alessia, Pavia Marco, Invernizzi Paolo, Amistà Pietro, Russo Monia, Filizzolo Marco, Mannino Marina, Galvano Gianluca, Saracco Eleonora Lidia, Bergui Mauro, Mangiafico Salvatore, Toni Danilo
机构信息
Neurology Unit (A.N., R.C.), San Giovanni Bosco Hospital, Turin, Italy.
Department of Neuroscience, University of Turin, Italy (F.D.).
出版信息
Stroke. 2025 Apr;56(4):850-857. doi: 10.1161/STROKEAHA.124.048997. Epub 2025 Mar 7.
BACKGROUND
The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke.
METHODS
We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age.
RESULTS
A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; <0.001) and predominantly female (71.7% versus 53%; <0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; <0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; =0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher.
CONCLUSIONS
Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.
背景
对于卒中前存在残疾（改良Rankin量表[mRS]评分为3至4分）且为前循环卒中的患者，机械取栓（MT）的获益和安全性仍不确定。本研究旨在利用意大利急性卒中血管内治疗注册中心的数据评估这些因素。
方法
我们分析了2015年至2021年期间收集的数据，比较了卒中前mRS评分为3至4分与0至2分的患者在MT术后90天时的功能结局（mRS）、症状性脑出血和再通率（脑梗死溶栓分级）。良好结局定义为mRS评分与基线相比无变化。亚组分析按年龄分层。
结果
共纳入11411例（96%）卒中前mRS评分为0至2分的患者和477例（4%）卒中前mRS评分为3至4分的患者。与基线mRS评分为0至2分的患者相比，mRS评分为3至4分的患者年龄更大（82岁对75岁；<0.001）且女性占比更高（71.7%对53%；<0.001）。卒中前mRS评分为3至4分的患者中，100例（23.3%）在MT术后mRS评分维持不变，而mRS评分为0至2分的患者中有2332例（22.1%）维持不变（P=0.556）。mRS评分为3至4分的组死亡率显著更高（n=159例[37.1%]对n=1939例[18.4%]；<0.
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