Kaffenberger Tina, Bernhardt Julie, Thijs Vincent N, Churilov Leonid, Johns Hannah, Sharma Gagan, Campbell Bruce C V, Yassi Nawaf
Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia.
Department of Neurology, Austin Health, Heidelberg, Australia (V.N.T.).
Stroke. 2025 Jul;56(7):1689-1692. doi: 10.1161/STROKEAHA.124.047349. Epub 2025 Apr 18.
The international trial AVERT (A Very Early Rehabilitation Trial) found that very early mobilization (VEM; commenced <24 hours after stroke) negatively affected functional outcome (modified Rankin Scale [mRS]). The drivers of this effect remain unclear. One plausible mechanism is that high-dose upright activity worsens cerebral perfusion in patients with cerebral large vessel occlusion (LVO). For this retrospective AVERT substudy, we collected brain imaging from participants from 8 AVERT sites (n=910) to explore the potential relationship between LVO, VEM, and mRS in ischemic stroke. We hypothesized that patients with evidence of LVO would be adversely affected by VEM compared with non-LVO patients.
In this post hoc analysis of a randomized controlled trial, 2 neurologists independently classified patients with ischemic stroke as having LVO via direct (vessel truncation on computed tomography/magnetic resonance imaging angiography) or indirect evidence (hyperdense artery sign or established infarction of >2/3 of an arterial territory) from brain imaging obtained ≤7 days poststroke. The associations between LVO, VEM, and 3- and 12-month mRS was tested using logistic regression, adjusted for age, treatment with thrombolysis, and baseline National Institutes of Health Stroke Scale.
Interrater reliability for LVO signs was high (weighted κ, 0.842 [95% CI, 0.631-0.969]). Of 689 participants (37.2% female; median age, 74.5 [interquartile range, 65.0-81.2] years) included in the primary analysis, 192 (28%) showed direct or indirect evidence of LVO. Computed tomography/magnetic resonance imaging angiography were available in 179 (26%) of those 689 participants. While LVO was associated with poor mRS (>2) at 3 months (adjusted odds ratio, 2.15 [95% CI, 1.29-3.64]) and 12 months (adjusted odds ratio, 1.76 [95% CI, 1.1-2.84]; =0.02), there was no significant interaction between VEM, LVO, and mRS (=0.16).
We found no evidence that VEM was specifically harmful in patients with LVO. However, as arterial imaging was not consistently obtained before first mobilization, larger prospective studies with standardized measures of LVO are needed to fully address this question.
URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=1266&isReview=true; Unique identifier: ACTRN12606000185561.
国际试验AVERT（一项极早期康复试验）发现，极早期活动（VEM；卒中后<24小时开始）对功能结局（改良Rankin量表[mRS]）产生负面影响。这种影响的驱动因素尚不清楚。一种合理的机制是，高剂量直立活动会使大脑大血管闭塞（LVO）患者的脑灌注恶化。在这项回顾性AVERT子研究中，我们收集了来自8个AVERT研究点的参与者（n = 910）的脑成像数据，以探讨LVO、VEM和缺血性卒中患者mRS之间的潜在关系。我们假设，与非LVO患者相比，有LVO证据的患者会受到VEM的不利影响。
在这项随机对照试验的事后分析中，2名神经科医生通过卒中后≤7天获得的脑成像直接（计算机断层扫描/磁共振成像血管造影上的血管截断）或间接证据（高密度动脉征或动脉区域>2/3的既定梗死），将缺血性卒中患者独立分类为患有LVO。使用逻辑回归检验LVO、VEM与3个月和12个月mRS之间的关联，并对年龄、溶栓治疗和基线美国国立卫生研究院卒中量表进行校正。
LVO体征的评分者间信度很高（加权κ，0.842[95%CI，0.631 - 0.969]）。在纳入主要分析的689名参与者（37.2%为女性；中位年龄，74.5[四分位间距，65.0 - 81.2]岁）中，192名（28%）显示有LVO的直接或间接证据。在这689名参与者中，179名（26%）有计算机断层扫描/磁共振成像血管造影数据。虽然LVO与3个月时较差的mRS（>2）（校正优势比，2.15[95%CI，1.29 - 3.64]）和12个月时（校正优势比，1.76[95%CI，1.1 - 2.84]；P = 0.02）相关，但VEM、LVO和mRS之间没有显著交互作用（P = 0.16）。
我们没有发现证据表明VEM对LVO患者有特别的危害。然而，由于在首次活动前未始终获得动脉成像，需要进行更大规模的前瞻性研究，并采用标准化的LVO测量方法来充分解决这个问题。
网址：https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 1266&isReview = true；唯一标识符：ACTRN12606000185561。
Zotero 插件