Karamchandani Rahul R, Wang Liang, Yang Hongmei, Strong Dale, Rhoten Jeremy B, Clemente Jonathan D, Defilipp Gary, Patel Nikhil M, Bernard Joe D, Stetler William R, Parish Jonathan M, Hines Andrew U, Patel Shraddha T, Saba Kasser, Tareen Tamour, Patel Harsh N, Bokka Satheesh K, Macko Lauren, Helms Anna Maria, Teli Katelynn J, Adelman Elizabeth A, Williams Laura, Retelski Julia, Wolfe Stacey Q, Asimos Andrew W
Department of Neurology, Neurosciences Institute, Wake Forest University School of Medicine, Atrium Health, Charlotte, NC, USA.
Clinical Quality Analytics, Atrium Health, Charlotte, NC, USA.
Interv Neuroradiol. 2025 Jul 23:15910199251362088. doi: 10.1177/15910199251362088.
BackgroundRecent randomized trials have shown that patients presenting with large core infarctions benefit from endovascular thrombectomy compared to medical management. We report real-world outcomes and factors associated with futile recanalization in patients meeting large core criteria for SELECT2.MethodsRetrospective review of health system records from 1/1/2024 to 12/31/2024 for patients presenting with computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) 3-5 or CT perfusion (CTP) core infarction ≥50 milliliters. Primary and secondary outcomes, 90-day modified Rankin Scale (mRS) score 0-2 and 0-3, respectively, were compared to rates reported in SELECT2. Logistic regression was used to identify factors independently associated with 90-day mRS 5-6 despite successful reperfusion (modified treatment in cerebral ischemia 2b-3).ResultsAmong 59 patients with 90-day outcome data, median CT ASPECTS and CTP core were 7 (5-10) and 78.5 (57-119) mL, respectively. Twelve (20.3%) achieved mRS 0-2, while 18 (30.5%) were ambulatory (mRS 0-3). Recanalization was achieved in 51 subjects, of whom 27 (52.9%) had a devastating neurological outcome (mRS 5-6). Atrial fibrillation was the only factor independently associated with futile recanalization (odds ratio 13.5, 95% confidence interval 1.4-128.8, < 0.05).ConclusionOur real-world cohort of large core thrombectomy patients from daily clinical practice had identical rates of independent neurological function and lower ambulatory rates at 90 days to that reported in the treatment arm of SELECT2. A history of atrial fibrillation, independent of age and presenting stroke severity, was associated with futile recanalization.
近期的随机试验表明，与药物治疗相比，出现大面积梗死核心的患者从血管内血栓切除术治疗中获益。我们报告了符合SELECT2大面积梗死核心标准的患者的真实世界结局以及与无效再通相关的因素。
回顾性分析2024年1月1日至2024年12月31日期间卫生系统记录中阿尔伯塔卒中项目早期CT评分（ASPECTS）为3 - 5或CT灌注（CTP）核心梗死≥50毫升的患者。将主要和次要结局，即90天改良Rankin量表（mRS）评分分别为0 - 2和0 - 3，与SELECT2报告的发生率进行比较。采用逻辑回归分析确定尽管成功再灌注（脑缺血改良治疗2b - 3）但90天mRS评分为5 - 6的独立相关因素。
在59例有90天结局数据的患者中，CT ASPECTS中位数和CTP核心梗死体积分别为7（5 - 10）和78.5（57 - 119）毫升。12例（20.3%）患者达到mRS 0 - 2，18例（30.5%）患者可独立行走（mRS 0 - 3）。51例患者实现了再通，其中27例（52.9%）出现严重神经功能缺损结局（mRS 5 - 6）。心房颤动是与无效再通独立相关的唯一因素（比值比13.5，95%置信区间1.4 - 128.8，P < 0.05）。
我们来自日常临床实践的大面积梗死核心血栓切除术患者的真实世界队列在90天时独立神经功能恢复率与SELECT2治疗组报告的相同，但可独立行走率较低。心房颤动病史，独立于年龄和卒中初发严重程度，与无效再通相关。
