Effect of occlusion site on the effectiveness and safety of endovascular thrombectomy for large ischemic cores: A cohort study.

IF 12.5 2区 医学 Q1 SURGERY International journal of surgery Pub Date : 2024-10-03 DOI:10.1097/JS9.0000000000002102
Shihai Yang, Lele Wu, Xiaolei Shi, Changwei Guo, Chengsong Yue, Shitao Fan, Jie Yang, Jiaxing Song, Dongsheng Ye, Xu Xu, Zhouzhou Peng, Linyu Li, Jiandi Huang, Chang Liu, Jiacheng Huang, Nizhen Yu, Yan Tian, Jinfu Ma, Dahong Yang, Weilin Kong, Zhixi Wang, Wenzhe Sun, Qingwu Yang, Boyu Chen, Wenjie Zi
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Abstract

Background: Recent clinical trials have shown that patients with large ischemic cores have better outcomes with endovascular thrombectomy (EVT) compared with standard medical treatment (SMT) alone.We aim to assess whether the relationship between EVT and improvements in clinical outcomes varies depending on the location of the occlusive sites.

Methods: This study is a subgroup analysis conducted within a prospective, nationwide, multi-center registry. The cohort included patients with acute large vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 0 to 5 within 24 hours from last known well. We utilized the adjusted common odds ratio for a shift toward better outcome on the modified Rankin Scale after EVT compared with SMT alone as the primary outcome. Safety outcomes included symptomatic intracranial hemorrhage (sICH).

Results: A total of 745 patients with large ischemic cores were included: 272(36.5%) with internal carotid artery occlusion, 392(52.6%) with M1 segment of the middle cerebral artery occlusion, and 81(11.0%) with M2 segment of the middle cerebral artery occlusion. The adjusted common odds ratios were as follows: 1.98 (95% CI, 1.01-3.89) for ICA occlusions, 2.09 (95% CI, 1.35-3.23) for M1 occlusions, and 1.13 (95% CI, 0.43-2.94) for M2 occlusions. There was no significant treatment-by-occlusion site interaction observed (P=0.69). However, the incidence of sICH was significantly greater in all groups receiving EVT than in those receiving SMT alone. Additionally, we observed that the secondary outcomes and subgroup analyses were generally consistent with the main outcomes.

Conclusions: In this study, we found that patients with internal carotid artery and M1 occlusion demonstrated a better outcome with EVT, while the benefit for patients with M2 occlusion remains uncertain.

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闭塞部位对血管内血栓切除术治疗大面积缺血核心的有效性和安全性的影响:一项队列研究。
背景:最近的临床试验表明,大面积缺血核心的患者接受血管内血栓切除术(EVT)与单纯的标准药物治疗(SMT)相比,疗效更好:本研究是在一项前瞻性、全国性、多中心登记中进行的亚组分析。研究对象包括前循环急性大血管闭塞、阿尔伯塔省卒中项目早期计算机断层扫描评分为 0 至 5 分的患者,这些患者均在 24 小时内死亡。我们将EVT后改良Rankin量表结果转好的调整后常见几率作为主要结果,而不是单纯的SMT。安全性结果包括症状性颅内出血(sICH):结果:共纳入了745名有大面积缺血核心的患者:结果:共纳入了 745 例有大缺血核心的患者:272 例(36.5%)颈内动脉闭塞,392 例(52.6%)大脑中动脉 M1 段闭塞,81 例(11.0%)大脑中动脉 M2 段闭塞。调整后的共同几率如下ICA闭塞为1.98(95% CI,1.01-3.89),M1闭塞为2.09(95% CI,1.35-3.23),M2闭塞为1.13(95% CI,0.43-2.94)。没有观察到治疗与闭塞部位之间的明显交互作用(P=0.69)。然而,所有接受EVT治疗组的sICH发生率都明显高于单纯接受SMT治疗组。此外,我们观察到次要结果和亚组分析与主要结果基本一致:在这项研究中,我们发现颈内动脉和M1闭塞患者接受EVT治疗的疗效更好,而M2闭塞患者的获益仍不确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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