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ECG-based machine learning model for AF identification in patients with first ischemic stroke. 基于心电图的机器学习模型,用于识别首次缺血性中风患者的房颤。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-13 DOI: 10.1177/17474930241302272
Chih-Chieh Yu, Yu-Qi Peng, Chen Lin, Chia-Hsin Chiang, Chih-Min Liu, Yenn-Jiang Lin, Lian-Yu Lin, Men-Tzung Lo

Background: The recurrence rate of strokes associated with atrial fibrillation (AF) can be substantially reduced through the administration of oral anticoagulants. However, previous studies have not demonstrated a clear benefit from the universal application of oral anticoagulants in patients with embolic stroke of undetermined source. Timely detection of AF remains a challenge in patients with stroke.

Aim: This study aims to develop a convolutional neural network (CNN) model to accurately identify patients with AF using a 12-lead sinus-rhythm electrocardiogram (ECG) recorded around the time of the first ischemic stroke. In addition, this study also evaluates the model's ability to predict future occurrence of AF.

Methods: A CNN model was trained with ECG data from patients at Taipei Veterans General Hospital. External validation was performed on ischemic stroke patients from National Taiwan University Hospital. The model's performance was assessed for detecting AF at the stroke event and predicting future AF occurrences.

Results: The model demonstrated an area under curve (AUC) of 0.91 for internal validation and 0.69 for external validation in identifying AF at the stroke event, with sensitivity and negative predictive value both achieving 97%. Kaplan-Meier survival analysis of patients without a prior diagnosis of AF revealed a significant increase in future AF incidence among the high-risk group identified by the model (adjusted hazard ratio: 4.06; 95% confidence interval: 2.74-6.00).

Conclusions: The CNN model effectively identifies AF in stroke patients using 12-lead ECGs and predicts future AF events, facilitating early anticoagulation therapy and potentially reducing recurrent stroke risk. Further prospective studies are warranted to confirm these findings.

背景:通过服用口服抗凝药可大大降低心房颤动(房颤)相关脑卒中的复发率。然而,以往的研究并未显示在来源不明的栓塞性中风患者中普遍应用口服抗凝剂有明显的益处。目的:本研究旨在开发一种卷积神经网络(CNN)模型,利用首次缺血性中风前后记录的 12 导联窦性心律心电图(ECG)准确识别房颤患者。此外,本研究还评估了该模型预测未来房颤发生的能力:方法:使用台北荣民总医院患者的心电图数据训练 CNN 模型。方法:使用台北荣民总医院患者的心电图数据训练 CNN 模型,并对台大医院的缺血性中风患者进行外部验证。方法:利用台北荣民总医院患者的心电图数据训练了一个 CNN 模型,并对国立台湾大学医院的缺血性中风患者进行了外部验证,评估了该模型在中风事件发生时检测房颤和预测未来房颤发生的性能:结果:该模型在识别中风时房颤方面的内部验证曲线下面积(AUC)为 0.91,外部验证为 0.69,灵敏度和阴性预测值均达到 97%。对既往未确诊房颤的患者进行的卡普兰-梅耶生存分析显示,该模型识别出的高危人群未来房颤发病率显著增加(调整后危险比:4.06;95% 置信区间:2.74-6.00):CNN 模型能通过 12 导联心电图有效识别卒中患者的房颤,并预测未来的房颤事件,从而促进早期抗凝治疗并降低复发性卒中风险。有必要开展进一步的前瞻性研究来证实这些发现。
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引用次数: 0
Carotid atherosclerotic plaque microcalcification is independently associated with recurrent neurovascular events: A pilot study. 颈动脉粥样硬化斑块微钙化与复发性神经血管事件独立相关:一项试点研究。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-27 DOI: 10.1177/17474930241264734
Shiv Bhakta, Jason M Tarkin, Mohammed M Chowdhury, James Hf Rudd, Elizabeth A Warburton, Nicholas R Evans

Background: Microcalcification and macrocalcification are critical processes in atherosclerotic plaque progression, though how these processes relate to the risk of stroke recurrence in symptomatic carotid atherosclerosis is poorly understood.

Methods: We performed a post hoc analysis of data from the ICARUSS (Imaging Carotid Atherosclerosis in the Recovery and Understanding of Stroke Severity) study, where individuals with acute ischemic stroke originating from ipsilateral carotid stenosis of ⩾ 50% underwent 18F-sodium fluoride positron emission tomography (NaF-PET) to measure microcalcification. Tracer uptake was quantified using maximum tissue-to-background ratio (TBRmax). Macrocalcification was measured on computed tomography (CT) using Agatston scoring. Patients were followed up for 6 months for recurrent ipsilateral neurovascular events.

Results: Five (27.8%) of 18 individuals had a recurrent ischemic stroke or transient ischemic attack. Ipsilateral carotid plaque NaF uptake at baseline was higher in those with recurrent events compared to those without, and this association remained after adjustment for other vascular risk factors (adjusted odds ratio (aOR) = 1.24, 1.03-1.50). Macrocalcification score in the symptomatic artery was also significantly independently associated with ipsilateral recurrence, but the effect size was relatively smaller (aOR = 1.12, 1.06-1.17 for each 100 unit increase).

Conclusions: Our findings indicate that microcalcification in symptomatic carotid plaques is independently associated with ipsilateral ischemic stroke recurrence. Furthermore, differences in the extent of active microcalcification in macrocalcified plaques may help explain variation in the relationship between calcified carotid plaques and stroke recurrence reported in the literature. Our pilot study indicates that evaluation of carotid artery microcalcification using NaF-PET may be a useful method for risk-stratification of carotid atherosclerosis, though our findings require confirmation in larger cohorts.

背景:微钙化和大钙化是动脉粥样硬化斑块进展的关键过程,但这些过程与无症状颈动脉粥样硬化中风复发风险的关系尚不清楚:我们对 ICARUSS 研究的数据进行了事后分析,在该研究中,同侧颈动脉狭窄≥50% 的急性缺血性中风患者接受了 18F 氟化钠正电子发射断层扫描(NaF-PET)以测量微钙化。示踪剂摄取采用最大组织与背景比值(TBRmax)进行量化。计算机断层扫描(CT)采用阿加斯顿评分法测量大钙化。对患者进行为期 6 个月的随访,以观察同侧神经血管事件的复发情况:结果:18 人中有 5 人(27.8%)再次发生缺血性中风或短暂性脑缺血发作。与未复发者相比,复发者同侧颈动脉斑块基线NaF摄取量更高,在调整其他血管风险因素后,这种关联仍然存在(OR 1.24,1.03-1.50)。无症状动脉的微钙化评分与同侧复发也有显著的独立相关性,但影响程度相对较小(OR 1.12,每增加100个单位,影响程度为1.06-1.17):我们的研究结果表明,无症状颈动脉斑块中的微钙化与同侧缺血性卒中复发密切相关。此外,大钙化斑块中活性微钙化程度的差异可能有助于解释文献中报道的颈动脉钙化斑块与中风复发之间关系的差异。我们的试验性研究表明,使用 NaF-PET 评估颈动脉微钙化可能是对颈动脉粥样硬化进行风险分层的一种有用方法,但我们的研究结果需要在更大的队列中得到证实。
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引用次数: 0
Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS. 基线 NIHSS 值较低的缺血性脑卒中患者再通路失败的预测因素
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-19 DOI: 10.1177/17474930241264737
Christian Heitkamp, Alexander Heitkamp, Laurens Winkelmeier, Christian Thaler, Fabian Flottmann, Maximilian Schell, Helge C Kniep, Gabriel Broocks, Jeremy J Heit, Gregory W Albers, Götz Thomalla, Jens Fiehler, Tobias D Faizy

Background: There is yet no randomized controlled evidence that mechanical thrombectomy (MT) is superior to best medical treatment in patients with large vessel occlusion but minor stroke symptoms (National Institutes of Health Stroke Scale (NIHSS) <6). Prior studies of patients with admission NIHSS scores 6 observed unfavorable functional outcomes despite successful recanalization, commonly termed as futile recanalization (FR), in up to 50% of cases.

Aim: The aim of this study is to determine the prevalence of FR in patients with minor stroke and identify associated patient-specific risk factors.

Methods: Our multicenter cohort study screened all patients prospectively enrolled in the German Stroke Registry Endovascular Treatment from 2015 to 2021 (n = 13,082). Included were patients who underwent MT for anterior circulation vessel occlusion with a baseline NIHSS score of <6 and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b-3). FR was defined by modified Rankin Scale (mRS) scores of 2-6 at 90 days. Multivariable logistic regression analysis was conducted to explore factors associated with FR.

Results: A total of 674 patients met the inclusion criteria. FR occurred in 268 (40%) patients. Multivariable logistic regression analysis indicates that higher age (adjusted odds ratio (aOR) = 1.04 (95% confidence interval (CI) = 1.02-1.06)), pre-stroke mRS 1 (aOR = 2.70 (95% CI = 1.51-4.84)), transfer from admission hospital to comprehensive stroke center (aOR = 1.67 (95% CI = 1.08-2.56)), longer time from symptom onset/last seen well to admission (aOR = 1.02 (95% CI = 1.00-1.04)), MT under general anesthesia (aOR = 1.78 (95% CI = 1.13-2.82)), higher NIHSS after 24 h (aOR = 1.09 (95% CI = 1.05-1.14)), and symptomatic intracranial hemorrhage (aOR = 16.88 (95% CI = 2.03-140.14)) increased the odds of FR. There was no significant difference in primary outcome between achieving mTICI score of 2b or 3.

Conclusions: Unfavorable functional outcomes despite successful vessel recanalization were frequent in acute ischemic stroke patients with low NIHSS scores on admission. We provide patient-specific risk factors that indicate an increased risk of FR and should be considered when treating patients with minor stroke.

Data accessibility statement: The data that support the findings of our study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee.

背景:目前尚无随机对照证据表明,对于大血管闭塞但有轻微卒中症状(美国国立卫生研究院卒中量表[NIHSS] 6)的患者,机械取栓术(MT)优于最佳药物治疗,尽管成功再通畅,但仍有高达50%的病例观察到不利的功能结果,通常称为徒劳再通畅(FR):我们的多中心队列研究筛选了 2015 年至 2021 年期间前瞻性加入德国卒中注册血管内治疗的所有患者(n=13082)。研究对象包括因前循环血管闭塞而接受MT治疗且基线NIHSS评分达到结果的患者:共有 674 名患者符合纳入标准。268例(40%)患者发生了FR。多变量逻辑回归分析表明,年龄越大(调整赔率:1.04 [95% 置信区间:1.02-1.06])、卒中前 mRS 1(aOR:2.70 [1.51-4.84])、从入院医院转至综合卒中中心(aOR:1.67 [1.08-2.56])、从症状发作/最后一次见好到入院的时间较长(aOR:1.02 [1.00-1.04])、全身麻醉下 MT(aOR:1.78 [1.13-2.82])、24 小时后 NIHSS 较高(aOR:1.09 [1.05-1.14])以及无症状颅内出血(aOR:16.88 [2.03-140.14])均会增加 FR 的几率。达到 mTICI 2b 或 3 的主要结果没有明显差异:入院时 NIHSS 评分较低的急性缺血性卒中患者尽管血管再通成功,但仍经常出现不利的功能预后。我们提供了患者的特异性风险因素,这些因素表明 FR 风险增加,在治疗轻微卒中患者时应加以考虑:经 GSR 指导委员会批准后,如有合理要求,可提供支持我们研究结果的数据。
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引用次数: 0
Author Index. 作者索引。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1177/17474930241306669
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引用次数: 0
Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy. 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。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub 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

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.

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。
{"title":"Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy.","authors":"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","doi":"10.1177/17474930241270524","DOIUrl":"10.1177/17474930241270524","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1123-1133"},"PeriodicalIF":6.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke. 急性缺血性脑卒中患者静脉溶栓后功能预后的性别差异趋势。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-02 DOI: 10.1177/17474930241273696
Martha Marko, Dominika Miksova, Melanie Haidegger, Jakob Schneider, Johanna Ebner, Marie B Lang, Wolfgang Serles, Stefan Kiechl, Michael Knoflach, Marek Sykora, Julia Ferrari, Thomas Gattringer, Stefan Greisenegger
<p><strong>Background: </strong>Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time.</p><p><strong>Aims: </strong>To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment.</p><p><strong>Methods: </strong>We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome.</p><p><strong>Results: </strong>Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women.</p><p><strong>Conclusions: </strong>Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences i
背景:静脉溶栓(IVT)是一种获准用于急性缺血性脑卒中患者的治疗方法,与性别无关。然而,目前有关 IVT 治疗后功能预后性别差异的文献并不一致。迄今为止,一些研究(包括之前基于奥地利卒中单元登记(ASUR)数据的分析)发现了功能预后中与性别相关的显著差异,而另一些研究则未报告男女之间存在任何差异。目的:评估全国性大型队列中缺血性脑卒中功能预后性别差异的时间趋势,并研究女性和男性患者特征与溶栓后功能预后的关联。尽管急性中风治疗取得了巨大进步,但功能预后的性别差异是否仍然存在,这些数据将为我们提供重要的见解:我们分析了 2006 年至 2021 年间 ASUR 的 39 个卒中中心接受 IVT 治疗的急性缺血性卒中连续患者的回顾性数据。我们纳入了接受 IVT 治疗的 18 岁以上急性缺血性脑卒中患者,并提供了治疗后 3 个月的功能预后数据。主要结果参数是 3 个月后的良好功能预后(修正的 Rankin 量表 (mRS) 为 0-2)。研究人员对所有患者进行了多变量逻辑回归分析,并按性别进行了分层,以评估基线特征与功能预后的关系:结果:在接受IVT治疗的11840名患者中,2489/5503(45.4%)名女性获得了良好的功能预后,而男性为3787/6337(59.8%)名。总体而言,女性性别是预测溶栓后功能预后的一个具有统计学意义的因素,但预测预后的其他因素在女性和男性之间存在差异。女性性别与实现功能独立的机会减少独立相关(adjOR 0.87,95%CI 0.79-0.96,p=0.005),我们发现随着时间的推移,只有男性的功能预后有统计学意义的改善(治疗年,adjOR(每年)1.04,95%CI 1.02-1.06,p结论:过去几年中,急性缺血性脑卒中 IVT 治疗后功能预后的性别差异持续存在。我们的分析结果可以提高人们的认识,因此关注预后预测因素的性别差异有助于在未来减轻这些差异,支持在临床常规中对患者进行更个体化的护理。需要进行后续分析,以评估这一潜在影响及其在未来的效果:奥地利卒中单元登记处的数据只能由受雇的统计学家(DM)访问,访问查询必须向登记处的学术审查委员会提出。
{"title":"Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke.","authors":"Martha Marko, Dominika Miksova, Melanie Haidegger, Jakob Schneider, Johanna Ebner, Marie B Lang, Wolfgang Serles, Stefan Kiechl, Michael Knoflach, Marek Sykora, Julia Ferrari, Thomas Gattringer, Stefan Greisenegger","doi":"10.1177/17474930241273696","DOIUrl":"10.1177/17474930241273696","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p &lt; 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences i","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1147-1154"},"PeriodicalIF":6.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
RhPro-UK in acute ischemic stroke within 4.5 h of stroke onset trial-2 (the PROST-2 study): Rationale and design of a multicenter, prospective, randomized, open-label, blinded-endpoint, controlled phase 3 non-inferiority trial. 英国 RhPro 在急性缺血性脑卒中发病 4.5 小时内治疗试验-2(PROST-2 研究):一项多中心、前瞻性、随机、开放标签、盲端点、对照的第 3 期非劣效性试验的原理与设计。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-03 DOI: 10.1177/17474930241265654
Shuya Li, Hong-Qiu Gu, Baoyu Feng, Qiang Dong, Dongsheng Fan, Yun Xu, Suiqiang Zhu, Yongjun Wang

Background: Recombinant prourokinase (rhPro-UK) is a specific plasmin activator, which has been approved to treat acute myocardial infarction in China.

Aim: This phase 3 trial aimed to further demonstrate the efficacy and safety of rhPro-UK in patients with acute ischemic stroke (AIS) within 4.5 h of symptom onset.

Methods and design: RhPro-UK in AIS within 4.5 h of stroke onset trial-2 (PROST-2) is a multicenter, prospective randomized, open-label, blinded end-point, non-inferiority, recombinant tissue plasmin activator (rt-PA)-controlled, phase 3 trial. A total of 1552 patients who are eligible for intravenous thrombolytic therapy from 72 clinical sites will be randomly assigned to receive either rhPro-UK 35 mg (15 mg bolus + 20 mg infusion/30 min) or rt-PA 0.9 mg/kg (10% bolus + 90% infusion/1 h).

Study outcomes: The primary outcome is the proportion of patients with a modified Rankin Scale (mRS) score of 0-1 at 90 days. Secondary efficacy outcomes include the proportion of patients with mRS score of 0-2, the distribution of mRS, self-care ability in daily life on the Barthel Index at 90 days, the proportion of subjects with ⩾ 4 points decrease in National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score ⩽ 1 from baseline at 24 h and 7 days after treatment. Safety outcomes are symptomatic intracranial hemorrhage (sICH) and major systematic bleeding within 7 days as well as death from all causes within 90 days.

Discussion: The results from the PROST-2 trial will comprehensively elucidate the efficacy and safety profile of rhPro-UK as a potential alternative agent for stroke thrombolysis.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT05700591.

研究背景重组人普鲁鲁激酶(rhPro-UK)是一种特异性纤溶酶原激活剂,在中国已被批准用于治疗急性心肌梗死。目的:本III期试验旨在进一步证明rhPro-UK在急性缺血性卒中(AIS)患者症状出现4.5小时内的疗效和安全性:RhPro-UK治疗发病4.5小时内急性缺血性脑卒中试验-2(PROST-2)是一项多中心、前瞻性、随机、开放标签、终点盲法、非劣效、重组组织纤溶酶原激活剂(rt-PA)对照的三期试验。72个临床站点的1552名符合静脉溶栓治疗条件的患者将被随机分配接受rhPro-UK 35毫克(15毫克注射+20毫克输注/30分钟)或rt-PA 0.9毫克/千克(10%注射+90%输注/1小时)治疗:主要研究结果是 90 天时改良 Rankin 量表(mRS)评分为 0-1 的患者比例。次要疗效指标包括:mRS 评分为 0-2 分的患者比例、mRS 的分布、90 天时 Barthel 指数的日常生活自理能力、治疗后 24 小时和 7 天时美国国立卫生研究院卒中量表(NIHSS)评分较基线下降≥4 分或 NIHSS 评分≤1 分的受试者比例。安全性结果为7天内出现症状性颅内出血(sICH)和重大系统性出血,以及90天内因各种原因死亡:PROST-2试验的结果将全面阐明rhPro-UK作为中风溶栓潜在替代药物的疗效和安全性:URL: http://www.clinicaltrials.gov.唯一标识符:NCT05700591。
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引用次数: 0
Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial. 晚窗大血管闭塞性脑卒中一线血栓切除技术与预后的关系;MR CLEAN-LATE 试验的事后分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241268303
Robrecht Rmm Knapen, Susanne Gh Olthuis, Adriaan Cgm van Es, Bart J Emmer, Wouter J Schonewille, Christiaan van der Leij, Wim H van Zwam, Robert J van Oostenbrugge

Background: This study aimed to compare direct aspiration, stent retriever, and the combined thrombectomy technique on clinical, safety, and technical outcomes in late-window stroke patients included in the MR CLEAN-LATE trial.

Methods: This post hoc analysis of the MR CLEAN-LATE trial included patients treated with direct aspiration, stent retriever, or combined thrombectomy technique as first-line approach. Primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, and compared between the three groups with ordinal logistic regression analysis. Secondary outcomes included mortality at 90 days, total technique switches, procedure time, recanalization rate measured with the expanded thrombolysis in cerebral infarction (eTICI) score, and symptomatic intracranial hemorrhage (sICH). Predefined variables were used for adjustments.

Results: In the MR CLEAN-LATE trial, 258 patients underwent endovascular treatment and 232 were included in our analyses. The mRS at 90 days did not differ (stent retriever vs. direct aspiration: adjusted common odds ratio (acOR) = 1.35, 95% confidence interval (CI) = 0.73 to 2.50; stent retriever vs. combined: acOR = 1.13, 95% CI = 0.64 to 2.00; direct aspiration vs. combined: acOR = 1.19, 95% CI = 0.64 to 2.21). Direct aspiration thrombectomy was accompanied with more switches to another technique compared to the stent retriever (adjusted odds ratio (aOR) = 6.50, 95% CI = 2.52 to 16.8) or combined group (aOR = 4.67, 95% CI = 1.80 to 12.1) and with higher sICH rates compared to the combined technique (13% vs. 2.5%; aOR = 8.19, 95% CI = 1.49 to 45.1). Mortality, procedure time, and eTICI did not differ.

Conclusion: Stent retriever, direct aspiration, or the combined thrombectomy technique as first-line approach showed no differences in clinical outcome in late-window stroke patients. Direct aspiration was accompanied with higher sICH rates and more switcher to another technique compared to the combined group.

背景:本研究旨在比较直接抽吸术、支架回取术和联合血栓切除术对 MR CLEAN-LATE 试验中的晚窗口期卒中患者的临床、安全性和技术结果:本研究旨在比较 MR CLEAN-LATE 试验中晚期脑卒中患者的直接抽吸、支架回取和联合血栓切除技术的临床、安全性和技术结果:这项 MR CLEAN-LATE 试验的事后分析包括采用直接抽吸、支架回取或联合血栓切除技术作为一线治疗方法的患者。主要结果是随访90天时的改良Rankin量表(mRS)评分,并通过序数逻辑回归分析对三组进行比较。次要结果包括90天时的死亡率、技术总转换次数、手术时间、用扩大脑梗塞溶栓(eTICI)评分测量的再通率以及症状性颅内出血(sICH)。结果:在MR CLEAN-LATE试验中,258名患者接受了血管内治疗,其中232人纳入了我们的分析。90天时的mRS没有差异(支架再障与直接抽吸:调整后的普通[ac] OR1.35,95%CI:0.73-2.50;支架再障与联合:acOR1.13,95%CI:0.64-2.00;直接抽吸与联合:acOR1.19,95%CI:0.64-2.21)。与支架回收器组(aOR:6.50,95%CI:2.52-16.8)或联合组(aOR:4.67,95%CI:1.80-12.1)相比,直接抽吸血栓切除术伴随着更多转用其他技术的情况,与联合技术相比,sICH 发生率更高(13% 对 2.5%;aOR: 8.19,95%CI:1.49-45.1)。死亡率、手术时间和eTICI没有差异:结论:支架回取术、直接抽吸术或联合血栓切除术作为一线治疗方法,在晚窗口期卒中患者的临床预后方面没有差异。与联合组相比,直接抽吸法的 sICH 发生率更高,且更多患者转用其他技术。
{"title":"Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial.","authors":"Robrecht Rmm Knapen, Susanne Gh Olthuis, Adriaan Cgm van Es, Bart J Emmer, Wouter J Schonewille, Christiaan van der Leij, Wim H van Zwam, Robert J van Oostenbrugge","doi":"10.1177/17474930241268303","DOIUrl":"10.1177/17474930241268303","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare direct aspiration, stent retriever, and the combined thrombectomy technique on clinical, safety, and technical outcomes in late-window stroke patients included in the MR CLEAN-LATE trial.</p><p><strong>Methods: </strong>This post hoc analysis of the MR CLEAN-LATE trial included patients treated with direct aspiration, stent retriever, or combined thrombectomy technique as first-line approach. Primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, and compared between the three groups with ordinal logistic regression analysis. Secondary outcomes included mortality at 90 days, total technique switches, procedure time, recanalization rate measured with the expanded thrombolysis in cerebral infarction (eTICI) score, and symptomatic intracranial hemorrhage (sICH). Predefined variables were used for adjustments.</p><p><strong>Results: </strong>In the MR CLEAN-LATE trial, 258 patients underwent endovascular treatment and 232 were included in our analyses. The mRS at 90 days did not differ (stent retriever vs. direct aspiration: adjusted common odds ratio (acOR) = 1.35, 95% confidence interval (CI) = 0.73 to 2.50; stent retriever vs. combined: acOR = 1.13, 95% CI = 0.64 to 2.00; direct aspiration vs. combined: acOR = 1.19, 95% CI = 0.64 to 2.21). Direct aspiration thrombectomy was accompanied with more switches to another technique compared to the stent retriever (adjusted odds ratio (aOR) = 6.50, 95% CI = 2.52 to 16.8) or combined group (aOR = 4.67, 95% CI = 1.80 to 12.1) and with higher sICH rates compared to the combined technique (13% vs. 2.5%; aOR = 8.19, 95% CI = 1.49 to 45.1). Mortality, procedure time, and eTICI did not differ.</p><p><strong>Conclusion: </strong>Stent retriever, direct aspiration, or the combined thrombectomy technique as first-line approach showed no differences in clinical outcome in late-window stroke patients. Direct aspiration was accompanied with higher sICH rates and more switcher to another technique compared to the combined group.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1113-1122"},"PeriodicalIF":6.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Insulin resistance and white matter microstructural abnormalities in nondiabetic adult: A population-based study. 非糖尿病成人的胰岛素抵抗和白质微结构异常:基于人群的研究
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-03 DOI: 10.1177/17474930241266796
Mengyuan Zhou, Yijun Zhou, Jing Jing, Mengxing Wang, Aoming Jin, Xueli Cai, Xia Meng, Tao Liu, Yongjun Wang, Yilong Wang, Yuesong Pan

Background: Insulin resistance (IR) is of growing concern yet its association with white matter integrity remains controversial. We aimed to investigate the association between IR and white matter integrity in nondiabetic adults.

Methods: This cross-sectional analysis was conducted based on the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. A total of 1709 nondiabetic community-dwelling adults with available diffusion-weighted imaging based on brain magnetic resonance imaging and completed oral glucose tolerance test were included. IR was measured noninvasively by insulin sensitivity indices (ISI), including ISIcomposite and ISI0,120, as well as homeostasis model assessment of insulin resistance (HOMA-IR). White matter microstructure abnormalities were identified by diffusion-weighted imaging along with tract-based spatial statistical analysis to compare diffusion metrics between groups. The multivariable linear regression models were applied to measure the association between white matter microstructure abnormalities and IR.

Results: A total of 1709 nondiabetic individuals with a mean age of 60.8 ± 6.4 years and 54.1% female were included. We found that IR was associated with a significant increase in mean diffusivity, axial diffusivity, and radial diffusivity extensively in cerebral white matter in regions such as the anterior corona radiata, superior corona radiata, anterior limb of internal capsule, external capsule, and body of corpus callosum. The pattern of associations was more marked for ISIcomposite and ISI0,120. However, the effect of IR on white matter integrity was attenuated after, in addition, adjustment for history of hypertension and cardiovascular disease and antihypertensive medication use.

Conclusion: Our findings indicate a significant association between IR and white matter microstructural abnormalities in nondiabetic middle-aged community residents, while these associations were greatly influenced by the history of hypertension and cardiovascular disease, and antihypertensive medication use. Further investigation is needed to clarify the role of IR in white matter integrity, whereas prophylactic strategies of maintaining a low IR status may ameliorate disturbances in white matter integrity.

Data accessibility statement: The data that support the findings of this study are available from the corresponding authors upon reasonable request.

背景:胰岛素抵抗(IR)日益受到关注,但其与白质完整性的关系仍存在争议。我们旨在研究非糖尿病成人胰岛素抵抗与白质完整性之间的关系:这项横断面分析是在多血管认知损害和血管事件评估(PRECISE)研究的基础上进行的。研究共纳入了 1709 名非糖尿病社区成人,这些成人均有基于脑磁共振成像的弥散加权成像,并完成了口服葡萄糖耐量试验。通过胰岛素敏感性指数(ISI)(包括 ISIcomposite 和 ISI0,120)以及胰岛素抵抗稳态模型评估(HOMA-IR)对胰岛素抵抗进行无创测量。白质微观结构异常是通过扩散加权成像和基于道的空间统计分析确定的,以比较不同组间的扩散指标。应用多变量线性回归模型测量白质微结构异常与 IR 之间的关系:共纳入 1709 名非糖尿病患者,平均年龄(60.8±6.4)岁,女性占 53.5%。我们发现,IR 与大脑白质的平均弥散度、轴向弥散度和径向弥散度的显著增加有关,这些区域包括放射状前冠、放射状上冠、内囊前肢、外囊和胼胝体主体。ISI复合指数和ISI0,120指数的关联模式更为明显。然而,在对高血压和心血管疾病史以及服用降压药进行额外调整后,胰岛素抵抗对白质完整性的影响有所减弱:我们的研究结果表明,在非糖尿病的中年社区居民中,胰岛素抵抗与白质微结构异常之间存在显著关联,而这些关联受高血压和心血管疾病史以及降压药使用情况的影响很大。要明确红外在白质完整性中的作用还需要进一步的研究,而保持低红外状态的预防性策略可能会改善白质完整性的紊乱。
{"title":"Insulin resistance and white matter microstructural abnormalities in nondiabetic adult: A population-based study.","authors":"Mengyuan Zhou, Yijun Zhou, Jing Jing, Mengxing Wang, Aoming Jin, Xueli Cai, Xia Meng, Tao Liu, Yongjun Wang, Yilong Wang, Yuesong Pan","doi":"10.1177/17474930241266796","DOIUrl":"10.1177/17474930241266796","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance (IR) is of growing concern yet its association with white matter integrity remains controversial. We aimed to investigate the association between IR and white matter integrity in nondiabetic adults.</p><p><strong>Methods: </strong>This cross-sectional analysis was conducted based on the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. A total of 1709 nondiabetic community-dwelling adults with available diffusion-weighted imaging based on brain magnetic resonance imaging and completed oral glucose tolerance test were included. IR was measured noninvasively by insulin sensitivity indices (ISI), including ISIcomposite and ISI<sub>0,120</sub>, as well as homeostasis model assessment of insulin resistance (HOMA-IR). White matter microstructure abnormalities were identified by diffusion-weighted imaging along with tract-based spatial statistical analysis to compare diffusion metrics between groups. The multivariable linear regression models were applied to measure the association between white matter microstructure abnormalities and IR.</p><p><strong>Results: </strong>A total of 1709 nondiabetic individuals with a mean age of 60.8 ± 6.4 years and 54.1% female were included. We found that IR was associated with a significant increase in mean diffusivity, axial diffusivity, and radial diffusivity extensively in cerebral white matter in regions such as the anterior corona radiata, superior corona radiata, anterior limb of internal capsule, external capsule, and body of corpus callosum. The pattern of associations was more marked for ISIcomposite and ISI<sub>0,120</sub>. However, the effect of IR on white matter integrity was attenuated after, in addition, adjustment for history of hypertension and cardiovascular disease and antihypertensive medication use.</p><p><strong>Conclusion: </strong>Our findings indicate a significant association between IR and white matter microstructural abnormalities in nondiabetic middle-aged community residents, while these associations were greatly influenced by the history of hypertension and cardiovascular disease, and antihypertensive medication use. Further investigation is needed to clarify the role of IR in white matter integrity, whereas prophylactic strategies of maintaining a low IR status may ameliorate disturbances in white matter integrity.</p><p><strong>Data accessibility statement: </strong>The data that support the findings of this study are available from the corresponding authors upon reasonable request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1162-1171"},"PeriodicalIF":6.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of intensive blood pressure lowering after multiple-attempt endovascular thrombectomy: A secondary analysis of the OPTIMAL-BP trial. 多次尝试血管内血栓切除术后强化降压的影响:OPTIMAL-BP 试验的二次分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1177/17474930241265652
Jae Wook Jung, Kwang Hyun Kim, Jaeseob Yun, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jin Kyo Choi, Hyung Lee, In Hwan Lim, Soon-Ho Hong, Byung Moon Kim, Dong Joon Kim, Na Young Shin, Bang-Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam

Background: Multiple attempts of thrombectomy have been linked to a higher risk of intracerebral hemorrhage and worsened functional outcomes, potentially influenced by blood pressure (BP) management strategies. Nonetheless, the impact of intensive BP management following successful recanalization through multiple attempts remains uncertain.

Aims: This study aimed to investigate whether conventional and intensive BP managements differentially affect outcomes according to multiple-attempt recanalization (MAR) and first-attempt recanalization (FAR) groups.

Methods: In this secondary analysis of the OPTIMAL-BP trial, which was a comparison of intensive (systolic BP target: <140 mm Hg) and conventional (systolic BP target = 140-180 mm Hg) BP managements during the 24 h after successful recanalization, we included intention-to-treat population of the trial. Patients were divided into the MAR and the FAR groups. We examined a potential interaction between the number of thrombectomy attempts (MAR and FAR groups) and the effect of BP managements on clinical and safety outcomes. The primary outcome was functional independence at 3 months. Safety outcomes were symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months.

Results: Of the 305 patients (median = 75 years), 102 (33.4%) were in the MAR group and 203 (66.6%) were in the FAR group. The intensive BP management was significantly associated with a lower rate of functional independence in the MAR group (intensive, 32.7% vs conventional, 54.9%, adjusted odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.90, p = 0.03). In the FAR group, the proportion of patients with functional independence was not significantly different between the BP managements (intensive, 42.5% vs conventional, 54.2%, adjusted OR = 0.73, 95% CI = 0.38-1.40). Incidences of symptomatic intracerebral hemorrhage and mortality rates were not significantly different according to the BP managements in both MAR and FAR groups.

Conclusions: Among stroke patients who received multiple attempts of thrombectomy, intensive BP management for 24 h resulted in a reduced chance of functional independence at 3 months and did not reduce symptomatic intracerebral hemorrhage following successful reperfusion.

背景:多次尝试血栓切除术与较高的脑内出血风险和功能预后恶化有关,这可能受到血压(BP)管理策略的影响。目的:本研究旨在根据多次尝试再通栓(MAR)组和首次尝试再通栓(FAR)组,探讨常规和强化血压管理是否会对预后产生不同影响:在这项对 OPTIMAL-BP 试验进行的二次分析中,对强化(收缩压目标值)和常规(收缩压目标值)血压管理结果进行了比较:在 305 名患者(中位数 75 岁)中,102 人(33.4%)属于 MAR 组,203 人(66.6%)属于 FAR 组。在 MAR 组中,强化血压管理与较低的功能独立率明显相关(强化组 32.7% 对常规组 54.9%,调整 OR 0.33,95% CI 0.12-0.90,p = 0.03)。在 FAR 组中,不同血压管理方法下功能独立的患者比例无明显差异(强化治疗 42.5%,常规治疗 54.2%,调整 OR 0.73,95% CI 0.38-1.40)。MAR组和FAR组的症状性脑出血发生率和死亡率在不同血压管理下没有明显差异:结论:在多次尝试血栓切除术的脑卒中患者中,24 小时的强化血压管理会降低患者 3 个月后功能独立的几率,并且不会减少再灌注成功后的症状性脑内出血。
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引用次数: 0
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International Journal of Stroke
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