在前循环和后循环缺血性卒中完全血管内再灌注后与神经功能延迟改善相关的因素。
Factors associated with delayed neurologic improvement after complete endovascular reperfusion in anterior and posterior ischemic stroke.
作者信息
Park Sangil, Kwon Boseong, Chang Jun Young, Song Yunsun, Lee Deok Hee, Ha Sang Hee, Kim Bum Joon
机构信息
Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea.
Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
出版信息
Front Neurol. 2025 May 30;16:1543743. doi: 10.3389/fneur.2025.1543743. eCollection 2025.
BACKGROUND
Mechanisms underlying delayed neurological improvement (DNI) after endovascular thrombectomy (EVT) in patients with anterior (ACS) and posterior circulation stroke (PCS) may differ. This study aims to compare the factors associated with DNI in patients with ACS and PCS.
MATERIALS AND METHODS
Data of patients who underwent EVT with National Institute of Health Stroke Scale (NIHSS) score more than 6 and achieved successful reperfusion were retrospectively analyzed. DNI was defined as achieving favorable functional outcomes at 90 days, even without early neurological improvement. The factors associated with DNI in patients with ACS and PCS were investigated.
RESULTS
A total of 241 patients were included. The proportions of DNI (30.8% vs. 20.0%; = 0.184) were not significantly different between patients with ACS and PCS. In patients with ACS, absence of atrial fibrillation (aOR = 0.500; 95% CI, 0.264-0.945; = 0.033), statin use (aOR = 2.842; 95% CI, 1.174-6.882; = 0.021), lower NIHSS score after 24 h (aOR = 0.816; 95% CI 0.757-0.880; < 0.001), and shorter onset-to-door time (aOR = 0.999; 95% CI, 0.998-1.000; = 0.025) were significantly associated with DNI. In patients with PCS, male sex (aOR = 31.809; 95% CI, 1.816-557.074; = 0.018) and lower initial NIHSS scores (aOR = 0.626; 95% CI, 0.410-0.957; = 0.031) were significantly associated with DNI.
CONCLUSION
The proportions of DNI were similar in patients with ACS and PCS. However, the factors associated with DNI were different between the two groups.
背景
前循环卒中（ACS）和后循环卒中（PCS）患者血管内血栓切除术（EVT）后延迟神经功能改善（DNI）的潜在机制可能不同。本研究旨在比较ACS和PCS患者中与DNI相关的因素。
材料与方法
回顾性分析国立卫生研究院卒中量表（NIHSS）评分大于6且成功再灌注的接受EVT治疗患者的数据。DNI定义为即使没有早期神经功能改善，在90天时仍能获得良好的功能结局。研究了ACS和PCS患者中与DNI相关的因素。
结果
共纳入241例患者。ACS和PCS患者的DNI比例（30.8%对20.0%；P = 0.184）无显著差异。在ACS患者中，无房颤（调整后比值比[aOR]=0.500；95%置信区间[CI]，0.264 - 0.945；P = 0.033）、使用他汀类药物（aOR = 2.842；95% CI，1.174 - 6.882；P = 0.021）、24小时后较低的NIHSS评分（aOR = 0.816；95% CI 0.757 - 0.880；P < 0.001）以及较短的发病至入院时间（aOR = 0.999；95% CI，0.998 - 1.000；P = 0.025）与DNI显著相关。在PCS患者中，男性（aOR = 31.809；95% CI，1.816 - 557.074；P = 0.018）和较低的初始NIHSS评分（aOR = 0.626；95% CI，0.410 - 0.957；P = 0.031）与DNI显著相关。
结论
ACS和PCS患者的DNI比例相似。然而，两组中与DNI相关的因素不同。
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