Casetta Ilaria, Pracucci Giovanni, Saia Valentina, Fainardi Enrico, Sallustio Fabrizio, Del Sette Bruno, Markushi Tiziana Benzi, Buonomo Orazio, Ferraù Ludovica, Bergui Mauro, Cerrato Paolo, Bracco Sandra, Tassi Rossana, Vallone Stefano, Bigliardi Guido, Lazzarotti Guido A, Giannini Nicola, Renieri Leonardo, Nencini Patrizia, Romano Daniele, Napoletano Rosa, Galluzzo Simone, Zini Andrea, Menozzi Roberto, Pezzini Alessandro, Mandruzzato Nicolò, Cappellari Manuel, Ruggiero Maria, Longoni Marco, Nappini Sergio, Mazzacane Federico, Burdi Nicola, Boero Giovanni, Cavasin Nicola, Critelli Adriana, Calzoni Andrea, Tassinari Tiziana, Saletti Andrea, Azzini Cristiano, Da Ros Valerio, Lacidogna Giordano, Zimatore Domenico S, Petruzzellis Marco, Castellano Davide, Naldi Andrea, Biraschi Francesco, Nicolini Ettore, Comai Alessio, Ora Elisa Dall', Lozupone Emilio, Caggiula Marcella, Gallesio Ivan, Ferrandi Delfina, Perri Marco, Sacco Simona, Besana Michele, Giossi Alessia, Carità Giuseppe, Russo Monia, Galvano Gianluca, Saracco Eleonora, Pavia Marco, Invernizzi Paolo, Filizzolo Marco, Mannino Marina, Puglielli Edoardo, Casalena Alfonsina, Mangiafico Salvatore, Toni Danilo
IRCCS San Camillo Hospital, 30126, Venice, Italy.
Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy.
J Neurol. 2025 Apr 2;272(4):308. doi: 10.1007/s00415-025-13026-y.
The impact of stroke etiology on outcomes in patients who underwent endovascular thrombectomy (EVT) is still a matter of debate. We studied the effect of aterosclerotic versus cardioembolic etiology on the clinical and radiological outcome of patients with stroke due to large vessel occlusion (LVO) treated with EVT on a large sample of stroke patients enrolled in a nationwide registry.
The source of data was the Italian Registry of Endovascular Stroke Treatments, a national, prospective, observational internet-based registry including patients treated with EVT since 2011. We extracted and compared data of patients suffering from large atherosclerosis (LAA) or cardioembolic (CE) stroke.
We included 5193 patients, 3899 CE, and 1294 LAA stroke. Patients with CE were significantly older (p < 0.001), and their stroke severity at admission was significantly higher (p < 0.001). Moreover, patients with LAA had significantly longer onset to end of procedure time, and procedure duration than CE patients. Good outcome at three months was reported in 45.2% of LAA and 45.4% of CE patients (p = 0.89). In the multivariable analysis, patients with CE had higher odds of achieving successful (OR = 1.61; 95% CI 1.35-1.92) or complete (OR = 1.40; 95% CI 1.21-1.62) recanalization Futile recanalization was detected more frequently in CE patients (OR = 1.35; 95% CI 1.18-1.61). There were no statistically significant differences in clinical outcomes (mRS 02: OR = 1.12; 95% CI 0.92-1.36). LAA patients had higher odds of sICH (OR = 0.65; 95% CI 0.49-0.85). The shift analysis showed a trend toward a better outcome in CE patients (OR = 1.19; 95% CI 0.99-1.35), which was statistically significant in subjects with anterior circulation stroke. (OR = 1.21; 95% CI 1.04-1.35).
The study showed a better chance of successful recanalization in CE patients, a slightly better outcome in CE patients with anterior circulation stroke after adjusting for baseline confounders, despite their more unfavourable risk factor profile, and a higher chance of futile recanalization.
卒中病因对接受血管内血栓切除术（EVT）患者预后的影响仍存在争议。我们在一个纳入全国范围内登记系统的大量卒中患者样本中，研究了动脉粥样硬化性病因与心源性栓塞病因对因大血管闭塞（LVO）接受EVT治疗的卒中患者临床和影像学预后的影响。
数据来源为意大利血管内卒中治疗登记系统，这是一个基于互联网的全国性前瞻性观察登记系统，纳入了自2011年以来接受EVT治疗的患者。我们提取并比较了患有大动脉粥样硬化（LAA）或心源性栓塞（CE）性卒中患者的数据。
我们纳入了5193例患者，其中3899例为CE性卒中和1294例为LAA性卒中。CE患者年龄显著更大（p<0.001），入院时卒中严重程度显著更高（p<0.001）。此外，LAA患者从发病到手术结束的时间和手术持续时间均显著长于CE患者。LAA患者和CE患者在3个月时良好预后的报告率分别为45.2%和45.4%（p = 0.89）。在多变量分析中，CE患者实现成功再通（OR = 1.61；95%CI 1.35 - 1.92）或完全再通（OR = 1.40；95%CI 1.21 - 1.62）的几率更高。CE患者中无效再通的检出频率更高（OR = 1.35；95%CI 1.18 - 1.61）。临床结局（改良Rankin量表0 - 2分）无统计学显著差异（OR = 1.12；95%CI 0.92 - 1.36）。LAA患者发生症状性颅内出血的几率更高（OR = 0.65；95%CI 0.49 - 0.85）。转换分析显示CE患者有预后更好的趋势（OR = 1.19；95%CI 0.99 - 1.35），这在伴有前循环卒中的患者中具有统计学显著性（OR = 1.21；95%CI 1.04 - 1.35）。
该研究表明，尽管CE患者的危险因素状况更不利，但在调整基线混杂因素后，CE患者成功再通的机会更大，伴有前循环卒中的CE患者预后略好，且无效再通的几率更高。
