Feng Zhiyuan, Yang Ming, Jin Aoming, Ma Ning, Gao Feng, Mo Dapeng, Liu Xiaojuan, Zhang Fangyuan, Li Xinchen, Li Yimeng, Chu Qi, Xue Jing, Cheng Aichun, Lin Jinxi, Li Hao, Meng Xia, Miao Zhongrong, Wang Yongjun, Xu Jie
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 S Fourth Ring W Rd, Fengtai District, Beijing, 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Neurol Ther. 2025 Mar 29. doi: 10.1007/s40120-025-00727-9.
Acute ischemic stroke with large vessel occlusion (AIS-LVO) is mainly caused by in situ thrombosis (IST), artery-to-artery embolism (AAE), and cardioembolism (CE). The clinical characteristics and prognosis of each mechanism are unclear in a real-world scenario.
We retrospectively analyzed patients with AIS-LVO who underwent endovascular treatment (EVT) between April 2023 and August 2024. Patients were classified according to three mechanisms. This study aimed to compare the clinical characteristics, lab results, EVT procedural factors, and prognosis of patients with AIS-LVO with three different mechanisms. The modified Rankin Scale (mRS) score at 3 months was the primary outcome, which was analyzed by ordinal logistic regression.
Among 162 patients included, IST (n = 81) was the most common mechanism, followed by CE (n = 41) and AAE (n = 40). Patients with CE showed more severe initial symptoms and the highest rate of intracranial hemorrhage. Patients with IST were associated with more rapid progression, more posterior circulation involvement, and higher inflammatory profile. Patients with AAE experienced a longer procedural time and had a higher rate of symptomatic intracranial hemorrhage (sICH). Although patients with IST and AAE more often required stenting, no significant difference in the rate of successful recanalization was found. The rates of mRS distribution (p = 0.24), and favorable outcomes at 3 months (p = 0.36) did not differ among the three groups. However, a trend towards better outcomes in the CE group was noted. On multivariable logistic regression, age (odds ratio, 0.97, 95% confidence interval, 0.95-1.00), pre-EVT National Institutes of Health Stroke Scale (NIHSS) (odds ratio, 0.94, 95% confidence interval, 0.89-0.98), and sICH (odds ratio, 0.33, 95% confidence interval, 0.12-0.95) could independently predict a favorable shift in mRS distribution. We failed to find that the mechanism was a predictor of the outcome.
The functional outcomes of patients with AIS-LVO were similar among different mechanisms, despite the sICH being much higher in patients with AAE. The optimal management for AIS-LVO with different mechanisms requires further research.
伴有大血管闭塞的急性缺血性卒中（AIS-LVO）主要由原位血栓形成（IST）、动脉到动脉栓塞（AAE）和心源性栓塞（CE）引起。在现实世界中，每种机制的临床特征和预后尚不清楚。
我们回顾性分析了2023年4月至2024年8月期间接受血管内治疗（EVT）的AIS-LVO患者。根据三种机制对患者进行分类。本研究旨在比较具有三种不同机制的AIS-LVO患者的临床特征、实验室检查结果、EVT手术因素和预后。3个月时的改良Rankin量表（mRS）评分是主要结局，通过有序逻辑回归进行分析。
在纳入的162例患者中，IST（n = 81）是最常见的机制，其次是CE（n = 41）和AAE（n = 40）。CE患者表现出更严重的初始症状和最高的颅内出血发生率。IST患者与疾病进展更快、后循环受累更多以及炎症指标更高相关。AAE患者手术时间更长，有症状性颅内出血（sICH）的发生率更高。尽管IST和AAE患者更常需要支架置入，但在成功再通率方面未发现显著差异。三组之间mRS分布率（p = 0.24）和3个月时的良好结局率（p = 0.36）没有差异。然而，注意到CE组有更好结局的趋势。在多变量逻辑回归分析中，年龄（比值比，0.97，95%置信区间，0.95 - 1.00）、EVT前美国国立卫生研究院卒中量表（NIHSS）评分（比值比，0.94，95%置信区间，0.89 - 0.98）和sICH（比值比，0.33，95%置信区间，0.12 - 0.95）可独立预测mRS分布的有利变化。我们未能发现机制是结局的预测因素。
尽管AAE患者的sICH发生率高得多，但不同机制的AIS-LVO患者的功能结局相似。针对不同机制的AIS-LVO的最佳管理需要进一步研究。
