急性缺血性卒中血管内治疗的患者特征、介入技术及结局的全国性趋势：MR CLEAN注册研究（2014 - 2018年）的最终结果
National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018).
作者信息
Hinsenveld Wouter H, Brouwer Josje, den Hartog Sanne J, Bruggeman Agnetha, Kappelhof Manon, Jansen Ivo Gh, Mulder Maxim Jhl, Compagne Kars Cj, Goldhoorn Robert-Jan B, Lingsma Hester, Lycklama À Nijeholt Geert, Gons Rob Ar, Yo Lonneke Fs, Uyttenboogaart Maarten, Bokkers Reinoud, van der Worp Bart H, Lo Rob H, Schonewille Wouter, Brouwers Paul, Bulut Tomas, Martens Jasper Mm, Hofmeijer Jeannette, van Hasselt Boudewijn Aam, den Hertog Heleen, de Bruijn Sebastiaan F, van Dijk Lukas C, van Walderveen Marianne A, Wermer Marieke, Boogaarts Hieronymus, van Dijk Ewoud J, van Tuijl Julia H, Boukrab Issam, Schreuder Tobien Ahcml, Heijboer Roeland, Rozeman Anouk D, Beenen Ludo Fm, Postma Alida A, Yoo Albert J, Roosendaal Stefan D, Bakker Jeannette, van Es Adriaan Cgm, Jenniskens Sjoerd, van den Wijngaard Ido Remy, Krietemeijer Menno, van den Berg René, Bot Joseph Cj, Hammer Sebastiaan, Sprengers Marieke, Meijer Frederick Jan Anton, Koopman Miou S, Ghariq Elyas, Appelman Auke Pa, van der Hoorn Anouk, van Proosdij Marc P, van der Kallen Bas Fw, Berkhemer Olvert A, Markenstein Jeroen E, Hendriks Eef J, Peluso Jo Pp, van der Leij Christiaan, Smagge Lucas, Vinke Saman, Pegge Sjoerd, Dinkelaar Wouter, Vos Jan Albert, Boiten Jelis, de Ridder Inger, Coutinho Jonathan, Emmer Bart J, van Doormaal Pieter Jan, Roozenbeek Bob, Roos Yvo Bwem, Majoie Charles Blm, Dippel Diederik Wj, van der Lugt Aad, van Zwam Wim, van Oostenbrugge Robert
机构信息
Department of Neurology, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands.
Department of Neurology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
出版信息
Eur Stroke J. 2025 May 2:23969873251334271. doi: 10.1177/23969873251334271.
INTRODUCTION
Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.
PATIENTS AND METHODS
Data from the MR CLEAN Registry (2014-2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS). Patients were grouped by year of inclusion except for the linear regression analysis where the inclusion date was used. Baseline predicted probability of poor outcome (modified Rankin Scale (mRS) score 3-6) was calculated using a validated prediction model. Primary outcome was mRS score at 90 days. Secondary outcomes included workflow times, EVT techniques, successful reperfusion (eTICI ⩾ 2B) and symptomatic intracranial haemorrhage (sICH). Time trends were analysed using multivariable regression models (adjusted common odds ratios (acOR) per year).
RESULTS
5193 patients were included. Median age increased (from 66 in 2014 to 74 years in 2018 [ < 0.001]). Proportion of patients with pre-stroke dependence (mRS ⩾ 3) increased from 2014 through 2018 (9% to 16%, < 0.001). Baseline predicted probability of poor outcome did not change (60% vs 66%, = 0.06). Over time, functional outcomes improved (acOR 1.14 per year, 95%CI: 1.09-1.20); mortality decreased (aOR 0.88 per year, 95%CI: 0.83-0.94). EVT under local anaesthesia increased (from 46% in 2014 to 70% in 2018; aOR 1.15, 95%CI: 1.10-1.22), as did use of direct aspiration (13%-36%; aOR 1.43, 95%CI: 1.35-1.53). Successful reperfusion became more frequent (aOR 1.32 per year, 95%CI: 1.25-1.40), despite needing more attempts (1 in 2014 vs 2 in 2018, aOR 0.93 per year, 95%CI: 0.89-0.98). Incidence of sICH remained unchanged (5% vs 5%, aOR 0.99 per year, 95%CI: 0.89-1.09). Time from emergency room to groin puncture reduced by 7 min per year (95%CI: 5-8).
DISCUSSION AND CONCLUSION
Enhanced workflow and increased EVT experience may have led to shorter time to treatment and more frequent successful reperfusion, with better functional outcomes over 5 years, despite treating older, more dependent patients.
引言
多年来，血管内血栓切除术（EVT）的手术操作和工作流程不断演变。我们研究了荷兰5年来患者特征、EVT技术及治疗结果的变化趋势。
患者与方法
对MR CLEAN注册研究（2014 - 2018年）的数据进行分析，纳入接受EVT治疗前循环急性缺血性卒中（AIS）的患者。除线性回归分析使用纳入日期外，患者按纳入年份分组。使用经过验证的预测模型计算预后不良（改良Rankin量表（mRS）评分3 - 6分）的基线预测概率。主要结局为90天时的mRS评分。次要结局包括工作流程时间、EVT技术、成功再灌注（eTICI⩾2B）及症状性颅内出血（sICH）。使用多变量回归模型（每年调整后的共同比值比（acOR））分析时间趋势。
结果
共纳入5193例患者。中位年龄增加（从2014年的66岁增至2018年的74岁[<0.001]）。卒中前有依赖（mRS⩾3）的患者比例从2014年到2018年有所增加（9%至16%，<0.001）。预后不良的基线预测概率未变化（60%对66%，P = 0.06）。随着时间推移，功能结局改善（每年acOR为1.14，95%CI：1.09 - 1.20）；死亡率降低（每年aOR为0.88，95%CI：0.83 - 0.94）。局部麻醉下的EVT增加（从2014年的46%增至2018年的70%；aOR为1.15，95%CI：1.10 - 1.22），直接抽吸的使用也增加（从13%增至36%；aOR为1.43，95%CI：1.35 - 1.53）。尽管需要更多尝试（2014年为1次，2018年为2次，每年aOR为0.93，95%CI：0.89 - 0.98），成功再灌注变得更频繁（每年aOR为1.32，95%CI：1.25 - 1.40）。sICH的发生率保持不变（5%对5%，每年aOR为0.99，95%CI：0.89 - 1.09）。从急诊室到股动脉穿刺的时间每年减少7分钟（95%CI：5 - 8）。
讨论与结论
尽管治疗的是年龄更大、依赖性更强的患者，但工作流程的优化和EVT经验的增加可能导致治疗时间缩短、成功再灌注更频繁，5年来功能结局更好。
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