Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-08-19 DOI:10.1177/17474930241270524
Vivek Yedavalli, Hamza Salim, Basel Musmar, Nimer Adeeb, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Yq Tan, Jeremy J Heit, Robert W Regenhardt, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Muhammed Amir Essibayi, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego, Adam A Dmytriw
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引用次数: 0

Abstract

Background: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.

Methods: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021.

Results: Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5-6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76.

Conclusions: This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.

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中血管闭塞脑卒中患者接受机械血栓切除术治疗后临床疗效极差的治疗前预测因素。
背景:原发性中血管闭塞(MeVO)引起的急性缺血性卒中(AIS)是一种常见病,与严重的发病率和死亡率有关。尽管在 AIS 中普遍使用机械性血栓切除术(MT),但中血管闭塞不良预后的预测因素仍不明确:在这项前瞻性收集、回顾性审查、多中心、跨国研究中,对来自 MAD-MT 登记处的数据进行了分析。研究纳入了来自北美、亚洲和欧洲37个学术中心的1568名患者,他们在2017年9月至2021年7月期间接受了机械血栓切除术(MT)治疗,无论是否使用静脉组织纤溶酶原激活剂(IVtPA):在1568名患者中,347人(22.2%)的预后极差(mRS 5-6)。不良预后的主要预测因素是高龄(OR:1.03;95% CI:1.02 至 1.04;P < 0.001)、较高的基线 NIHSS 评分(OR:1.07;95% CI:1.05 至 1.10;p < 0.001)、术前血糖水平(OR:1.01;95% CI:1.00 至 1.02;p < 0.001)和基线 mRS 为 4(OR:2.69;95% CI:1.25 至 5.82;p = 0.011)。多变量模型显示出良好的预测准确性,接收器操作特征曲线下面积为 0.76:本研究表明,高龄、较高的 NIHSS 评分、卒中前 mRS 升高和术前葡萄糖水平可显著预测接受 MT 的 AIS-MeVO 患者的极差预后。这些发现强调了对原发性 MeVO 患者进行全面风险评估以制定个性化治疗策略的重要性。不过,这些发现也表明,在选择患者进行血管内血栓切除术时需要谨慎。还需要进一步的前瞻性研究来证实这些发现,并探索有针对性的治疗干预措施。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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