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Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke. 在农村地区进行院前计算机断层扫描,以快速诊断和治疗中风。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-28 DOI: 10.1177/23969873241267084
Jørgen Ibsen, Maren Ranhoff Hov, Gunn Eli Tokerud, Julia Fuglum, Marianne Linnerud Krogstad, Marie Stugaard, Hege Ihle-Hansen, Christian Georg Lund, Christian Hall

Background: Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times.

Methods: Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017-2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group).

Results: A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups.

Conclusion: Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.

背景:缺血性脑卒中患者的早期诊断和分流对于快速再灌注治疗至关重要。院前延误的时间可能很长,来自农村地区的患者由于转运时间过长,往往来不及到当地医院接受预防残疾的溶栓治疗。我们在 HDMC 建立了对急性缺血性中风患者进行 CT 成像和溶栓治疗的紧急路径。在上班时间,这些路径由一名放射技师和一名全科医生通过视频会议从初级卒中中心提供支持。非办公时间,我们远程控制 CT 检查,并支持远程卒中指导护理人员处理和检查患者。为了证明这一全新理念的可行性,我们在 2017-2021 年期间招募患者参与一项队列比较观察研究。我们将在HDMC接受治疗的患者(农村CT组)与挪威另外两个农村地区的患者(参照组)进行了比较,这两个地区距离当地医院的距离相似,但没有农村CT扫描仪:农村 CT 组共有 86 名患者(平均年龄 74 岁,52% 为男性,43% 为中风模拟患者),参照组共有 69 名患者(平均年龄 70 岁,42% 为男性,28% 为中风模拟患者)。农村 CT 组患者从症状出现到完成 CT 检查的中位时间为 93 分钟,而参照组患者为 240 分钟(P P 结论:将院前农村 CT 检查与远程卒中指导诊断和辅助医务人员溶栓治疗相结合,有助于缺血性卒中患者更早地开始溶栓治疗。
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引用次数: 0
Response to Xu et al: Time-to-event analysis, data variability, and consideration of model selection: Considerations in relation to stroke-heart syndrome. 对 Xu 等人的回应:从时间到事件的分析、数据的可变性以及对模型选择的考虑:与中风-心脏综合征有关的考虑因素。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-28 DOI: 10.1177/23969873241287131
Benjamin Jr Buckley, Gregory Yh Lip
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引用次数: 0
Depressive symptoms profile and dementia risk after spontaneous intracerebral haemorrhage. 自发性脑出血后的抑郁症状概况和痴呆症风险。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-26 DOI: 10.1177/23969873241284725
Giuseppe Scopelliti, Maéva Kyheng, Barbara Casolla, Grégory Kuchcinski, Grégoire Boulouis, Solène Moulin, Julien Labreuche, Hilde Hénon, Marco Pasi, Charlotte Cordonnier

Introduction: Depressive symptoms are commonly reported after spontaneous intracerebral haemorrhage (ICH) and frequently associated with cognitive decline. Using hierarchical clustering analysis (HCA), we aimed to identify different post-ICH depressive symptoms profiles and to evaluate their association with dementia risk.

Methods: We included consecutive patients from the prospective Prognosis of Intracerebral Haemorrhage (PITCH) study who survived 6 months after the ICH. We performed HCA using depressive symptoms severity (assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS)), along with the presence of apathy and anxiety (screened using Neuropsychiatric Inventory questionnaire). Baseline clinical/neuroimaging characteristics and risk of incident dementia were compared between different profiles using univariate and multivariable models.

Results: Of 265 six-month ICH survivors, 221 (83%) underwent neuropsychiatric screening (mean age 65.5 years; 57% male). Using HCA, 3 profiles were identified: (1) without significant depressive symptoms (n = 152; median MADRS score = 2 [IQR 0-4]); (2) depressive symptoms with predominant apathy (n = 41; median MADRS score = 15 [IQR 5-20], 68% with apathy); (3) depressive symptoms profile with predominant anxiety (n = 28; median MADRS score = 17 [IQR 9-25]; 100% with anxiety). Compared to patients without depressive symptoms, patients with depressive symptoms and predominant apathy (but not those with predominant anxiety) were more likely to have cerebral atrophy (OR = 2.4, 95% CI = 1.4-4.2) and had significantly higher long-term new-onset dementia risk (adjusted hazard ratio = 2.2, 95% CI = 1.3-3.8).

Conclusion: Screening for apathy and anxiety on top of depressive symptoms might help identifying patients at risk for dementia. Future studies on treatment should account for different post-ICH depressive symptoms profiles that may impact on cognitive function.

简介:抑郁症状是自发性脑出血(ICH)后的常见症状,通常与认知能力下降有关。我们采用分层聚类分析(HCA),旨在确定不同的 ICH 后抑郁症状特征,并评估它们与痴呆风险的关系:我们纳入了前瞻性脑出血预后(PITCH)研究中在 ICH 后存活 6 个月的连续患者。我们使用抑郁症状严重程度(使用蒙哥马利-奥斯伯格抑郁评定量表(MADRS)进行评估)以及是否存在冷漠和焦虑(使用神经精神量表问卷进行筛查)进行了 HCA 评估。采用单变量和多变量模型比较了不同类型患者的基线临床/神经影像学特征和痴呆症发病风险:在 265 名存活六个月的 ICH 患者中,221 人(83%)接受了神经精神病学筛查(平均年龄 65.5 岁;57% 为男性)。通过 HCA 筛选,确定了 3 种情况:(1)无明显抑郁症状(152 人;MADRS 中位数评分 = 2 [IQR0-4]);(2)抑郁症状以冷漠为主(41 人;MADRS 中位数评分 = 15 [IQR5-20],68% 患有冷漠);(3)抑郁症状以焦虑为主(28 人;MADRS 中位数评分 = 17 [IQR9-25];100% 患有焦虑)。与无抑郁症状的患者相比,有抑郁症状且以冷漠为主的患者(但不包括以焦虑为主的患者)更有可能出现脑萎缩(OR = 2.4,95% CI = 1.4-4.2),且长期新发痴呆症的风险明显更高(调整后危险比 = 2.2,95% CI = 1.3-3.8):结论:在抑郁症状的基础上筛查冷漠和焦虑可能有助于识别痴呆症高危患者。未来的治疗研究应考虑到ICH后不同抑郁症状对认知功能的影响。
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引用次数: 0
Addressing biases: Evaluating the Cox proportional hazards model and alternative approaches for major adverse cardiovascular events research. 消除偏见:评估主要心血管不良事件研究中的 Cox 比例危险模型和替代方法。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-19 DOI: 10.1177/23969873241286984
Lingyu Xu, Bin Zhou, Yan Xu
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引用次数: 0
Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy. 机械取栓术治疗大脑中动脉 M2 段血管闭塞中风随访梗死体积对功能预后的预测价值。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.1177/23969873241275531
Vivek Yedavalli, Hamza Adel 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, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, 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, Muhammed Amir Essibayi, 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: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT.

Methods: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT.

Results: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes.

Conclusions: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

背景:中血管闭塞(MeVO)脑卒中,尤其是影响大脑中动脉 M2 段的中血管闭塞,在急性缺血性脑卒中中占有重要比例,给管理和预后带来了巨大挑战。机械性血栓切除术(MT)在MeVO脑卒中中的疗效可能需要可靠的功能预后预测指标。本研究旨在探讨随访梗死体积(FIV)对预测接受MT治疗的MeVO卒中患者90天功能预后的预后价值:这项多中心、回顾性队列研究分析了 "原发性远端中血管闭塞多中心分析:机械取栓术(MAD-MT)的影响 "登记处的数据,涵盖了接受 MT 治疗的 M2 段闭塞所致急性缺血性卒中患者。我们研究了以改良兰金量表(mRS)衡量的 90 天功能预后与后续梗死体积(FIV)之间的关系,FIV 是在 MAD-MT 术后 12-36 小时内通过 CT 或 MRI 评估的:结果:在130名参与者中,确定了特定的FIV阈值,其特异性和灵敏度都很高,可预测结果。FIV ⩽5 毫升对预测良好和卓越预后具有高度特异性。根据尤登指数(Youden Index),两种预后的最佳临界值均为⩽15 毫升,超过 40 毫升临界值后,预后良好的可能性显著降低。受体运算曲线(ROC)分析证实,与传统的再通化评分(如最终的改良脑梗塞溶栓评分(mTICI))相比,FIV能更好地预测功能预后。多变量分析进一步强调了FIV与积极功能预后之间的反向关系:结论:MT后36小时内的FIV是M2段MeVO脑卒中患者90天功能预后的有力预测指标。建立 FIV 阈值可帮助预测脑卒中的预后,表明 FIV 在指导干预后治疗决策和临床实践中的作用。未来的研究应侧重于在不同的患者群体中验证这些发现,并探索将 FIV 测量与其他临床和影像学标记物相结合,以提高预后预测的准确性。
{"title":"Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy.","authors":"Vivek Yedavalli, Hamza Adel 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, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, 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, Muhammed Amir Essibayi, 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":"10.1177/23969873241275531","DOIUrl":"https://doi.org/10.1177/23969873241275531","url":null,"abstract":"<p><strong>Background: </strong>Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT.</p><p><strong>Results: </strong>Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes.</p><p><strong>Conclusions: </strong>FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Association between angiographic and clinical outcomes after STA-MCA bypass in adult moyamoya disease. 成人 moyamoya 病 STA-MCA 分流术后血管造影与临床结果之间的关联。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-11 DOI: 10.1177/23969873241278193
Guicheng Kuang, Hang Ji, Jixuan Zheng, Xinchen Li, Kejin Luo, Yajun Hu, Zheyuan Zhang, Haogeng Sun

Background and purpose: As an angiographic outcome, postoperative collateral formation (PCF) is commonly used to evaluate the effect of STA-MCA bypass in moyamoya disease (MMD), but whether it can reliably reflect clinical outcomes is still unclear. We investigated the association between PCF and clinical outcomes in adult MMD.

Methods: All STA-MCA bypass procedures performed from January 2013 to December 2019 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. The clinical outcomes consisted of symptom improvement and recurrent cerebrovascular events. Logistic and Cox regression and Kaplan-Meier analyses were performed to explore the association between PCF and clinical outcomes.

Results: Of 165 included symptomatic hemispheres of 154 patients, 104 (63.0%) and 61 (37.0%) had good and poor PCF, respectively. The hemispheres with good PCF were younger (p = 0.004) and had a higher incidence of hemodynamic dysfunction on admission (p < 0.001) than those with poor PCF. Multivariate logistic regression analysis showed that the good PCF (odd ratio, 28.96; 95% confidence interval (CI), 9.12-91.98; p < 0.001) was associated with a higher incidence of symptom improvement. Multivariate Cox regression analysis showed that the poor PCF (hazard ratio, 3.77; 95% CI, 1.31-10.84; p = 0.014) was associated with a higher incidence of recurrent cerebrovascular events. In the hemorrhagic-onset hemispheres, good PCF group had a higher incidence of symptom improvement (p < 0.001) and a longer hemorrhage-free time (p = 0.031). In the ischemic-onset hemispheres, good PCF group also had a higher incidence of symptom improvement (p < 0.001) and a longer ischemia-free time (p = 0.028).

Conclusions: As a angiographic outcome, collateral formation is a qualified surrogate measure for clinical outcomes after STA-MCA bypass in adult MMD.

背景和目的:作为一种血管造影结果,术后侧支形成(PCF)通常用于评估STA-MCA搭桥术在moyamoya病(MMD)中的效果,但它是否能可靠地反映临床结果仍不清楚。我们研究了 PCF 与成人 MMD 临床预后之间的关系:这项前瞻性队列研究筛选了 2013 年 1 月至 2019 年 12 月期间实施的所有 STA-MCA 搭桥术。纳入获得术前和随访导管血管造影的患者。临床结果包括症状改善和复发性脑血管事件。研究人员进行了逻辑回归、Cox回归和Kaplan-Meier分析,以探讨PCF与临床结局之间的关联:在154名患者的165个有症状半球中,分别有104个(63.0%)和61个(37.0%)半球的PCF良好和不良。PCF良好的半球更年轻(p = 0.004),入院时血流动力学功能障碍的发生率更高(p p = 0.014),这与复发性脑血管事件的发生率较高有关。在出血性发病的半球中,PCF良好组症状改善的发生率更高(P P = 0.031)。在缺血发作的半球中,PCF良好组症状改善的发生率也更高(P = 0.028):作为血管造影结果,侧支形成是衡量成人多发性硬化症患者 STA-MCA 搭桥术后临床结果的合格替代指标。
{"title":"Association between angiographic and clinical outcomes after STA-MCA bypass in adult moyamoya disease.","authors":"Guicheng Kuang, Hang Ji, Jixuan Zheng, Xinchen Li, Kejin Luo, Yajun Hu, Zheyuan Zhang, Haogeng Sun","doi":"10.1177/23969873241278193","DOIUrl":"https://doi.org/10.1177/23969873241278193","url":null,"abstract":"<p><strong>Background and purpose: </strong>As an angiographic outcome, postoperative collateral formation (PCF) is commonly used to evaluate the effect of STA-MCA bypass in moyamoya disease (MMD), but whether it can reliably reflect clinical outcomes is still unclear. We investigated the association between PCF and clinical outcomes in adult MMD.</p><p><strong>Methods: </strong>All STA-MCA bypass procedures performed from January 2013 to December 2019 were screened in this prospective cohort study. Patients who acquired presurgical and follow-up catheter angiography were included. The clinical outcomes consisted of symptom improvement and recurrent cerebrovascular events. Logistic and Cox regression and Kaplan-Meier analyses were performed to explore the association between PCF and clinical outcomes.</p><p><strong>Results: </strong>Of 165 included symptomatic hemispheres of 154 patients, 104 (63.0%) and 61 (37.0%) had good and poor PCF, respectively. The hemispheres with good PCF were younger (<i>p</i> = 0.004) and had a higher incidence of hemodynamic dysfunction on admission (<i>p</i> < 0.001) than those with poor PCF. Multivariate logistic regression analysis showed that the good PCF (odd ratio, 28.96; 95% confidence interval (CI), 9.12-91.98; <i>p</i> < 0.001) was associated with a higher incidence of symptom improvement. Multivariate Cox regression analysis showed that the poor PCF (hazard ratio, 3.77; 95% CI, 1.31-10.84; <i>p</i> = 0.014) was associated with a higher incidence of recurrent cerebrovascular events. In the hemorrhagic-onset hemispheres, good PCF group had a higher incidence of symptom improvement (<i>p</i> < 0.001) and a longer hemorrhage-free time (<i>p</i> = 0.031). In the ischemic-onset hemispheres, good PCF group also had a higher incidence of symptom improvement (<i>p</i> < 0.001) and a longer ischemia-free time (<i>p</i> = 0.028).</p><p><strong>Conclusions: </strong>As a angiographic outcome, collateral formation is a qualified surrogate measure for clinical outcomes after STA-MCA bypass in adult MMD.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database. 早期使用他汀类药物与改善心房颤动和近期缺血性中风患者的生存率和心血管预后有关:对全球联合健康数据库的倾向匹配分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-10 DOI: 10.1177/23969873241274213
Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim

Introduction: Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.

Patients and methods: This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).

Results: Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.

Discussion and conclusion: Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.

简介:他汀类药物可减少非心血管栓塞性中风患者的复发性中风和心血管事件。他汀类药物对房颤和近期发生过 IS 的患者的益处尚不清楚。我们旨在研究他汀类药物对房颤和近期发生 IS 的患者的益处:这项回顾性队列研究使用 TriNetX 平台中的去身份化电子病历。心房颤动和近期IS患者在中风发生后28天内接受了他汀类药物治疗,并与未接受他汀类药物治疗的患者进行了倾向评分匹配。对患者进行了长达 2 年的随访。主要结果是两年内IS复发风险、全因死亡率以及全因死亡率、IS复发、短暂性脑缺血发作(TIA)和急性心肌梗死(MI)的综合结果。次要结果是 TIA、颅内出血 (ICH)、急性心肌梗死和再次入院的 2 年风险。采用 Cox 回归分析计算危险比(HRs)和 95% 置信区间(95%CI):在 20902 名房颤且近期发生过 IS 的患者中,7500 人(35.9%)在中风后 28 天内服用了他汀类药物,13402 人(64.1%)未服用。经过倾向得分匹配后,仍有 11182 名患者(平均年龄为 73.7 ± 11.5;5277 人(47.2%)为女性)接受了他汀类药物治疗。早期接受他汀类药物治疗的患者复发IS的风险明显降低(HR:0.45,95%CI:0.41-0.48,p p p p p p 5个亚组):讨论与结论:与未接受他汀类药物治疗的患者相比,接受早期他汀类药物治疗的房颤和近期IS患者发生卒中复发、死亡和其他心血管后果(包括ICH)的风险较低。
{"title":"Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.","authors":"Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Kai-Hang Yiu, Christopher Tw Tsang, Kui Kai Lau, Andrew Hill, Greg Irving, Gregory Yh Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241274213","DOIUrl":"https://doi.org/10.1177/23969873241274213","url":null,"abstract":"<p><strong>Introduction: </strong>Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS.</p><p><strong>Patients and methods: </strong>This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI).</p><p><strong>Results: </strong>Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, <i>p</i> < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, <i>p</i> < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, <i>p</i> < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, <i>p</i> < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, <i>p</i> < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, <i>p</i> < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups.</p><p><strong>Discussion and conclusion: </strong>Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Endovascular treatment in patients with acute ischemic stroke presenting beyond 6 h after symptom onset: An international multicenter cohort study of the EVA-TRISP collaboration. 急性缺血性脑卒中患者症状出现 6 小时后的血管内治疗:EVA-TRISP合作组织的一项国际多中心队列研究。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-08 DOI: 10.1177/23969873241277437
Nabila Wali, Lotte J Stolze, Leon A Rinkel, Mirjam R Heldner, Madlaine Müller, Marcel Arnold, Pasquale Mordasini, Jan Gralla, Philipp Baumgartner, Corinne Inauen, Laura P Westphal, Susanne Wegener, Patrik Michel, Simon Trüssel, Laura Mannismäki, Nicolas Martinez-Majander, Sami Curtze, Georg Kägi, Livio Picchetto, Maria Luisa Dell'Acqua, Guido Bigliardi, Christoph Riegler, Christian H Nolte, Miguel Serôdio, Miguel Miranda, João Pedro Marto, Andrea Zini, Stefano Forlivesi, Luana Gentile, Carlo W Cereda, Alessandro Pezzini, Ronen R Leker, Asaf Honig, Ivana Berisavac, Visnja Padjen, Marialuisa Zedde, Laurien S Kuhrij, Renske M Van den Berg-Vos, Stefan T Engelter, Henrik Gensicke, Paul J Nederkoorn

Introduction: After positive findings in clinical trials the time window for endovascular thrombectomy (EVT) for patients with an acute ischemic stroke has been expanded up to 24 h from symptom onset or last seen well (LSW). We aimed to compare EVT patients' characteristics and outcomes in the early versus extended time window and to compare outcomes with the DAWN and DEFUSE 3 trial results.

Patients and methods: Consecutive EVT patients from 16 mostly European comprehensive stroke centers from the EVA-TRISP cohort were included. We compared rates of 90-day good functional outcomes (Modified Rankin Scale 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality between patients treated in the early (<6 h after onset or LSW) versus extended (6-24 h after onset or LSW) time windows.

Results: We included 9313 patients, of which 6876 were treated in the early and 2437 in the extended time window. National Institutes of Health Stroke Scale (NIHSS) score at presentation was lower in patients treated in the extended time window (median 13 [IQR 7-18] vs 15 [IQR 9-19], p < 0.001). The percentage of patients with good functional outcome was slightly lower in the extended time window (37.4% vs 42.2%, p < 0.001). However, rates of successful recanalization, sICH, and mortality were similar. Good functional outcome rates after EVT were slightly lower for patients in the extended window in the EVA-TRISP cohort as compared to DAWN and DEFUSE 3.

Discussion and conclusion: According to this large multicenter cohort study reflecting daily clinical practice, EVT use in the extended time window appears safe and effective.

简介:在临床试验取得积极成果后,急性缺血性脑卒中患者接受血管内血栓切除术(EVT)的时间窗口已延长至症状出现或最后一次就诊(LSW)后的 24 小时。我们的目的是比较早期和延长时间窗内 EVT 患者的特征和结果,并将结果与 DAWN 和 DEFUSE 3 试验结果进行比较:患者和方法: 我们纳入了来自 EVA-TRISP 队列中 16 个欧洲综合性卒中中心的连续 EVT 患者。我们比较了早期治疗患者的 90 天良好功能预后率(改良 Rankin 量表 0-2)、症状性颅内出血率(sICH)和 90 天死亡率:我们纳入了 9313 例患者,其中 6876 例在早期接受治疗,2437 例在延长时间窗接受治疗。美国国立卫生研究院卒中量表(NIHSS)评分在延长时间窗治疗的患者中较低,中位数为 13 [IQR 7-18] vs 15 [IQR 9-19], p p 讨论与结论:根据这项反映日常临床实践的大型多中心队列研究,在延长时间窗内使用 EVT 似乎安全有效。
{"title":"Endovascular treatment in patients with acute ischemic stroke presenting beyond 6 h after symptom onset: An international multicenter cohort study of the EVA-TRISP collaboration.","authors":"Nabila Wali, Lotte J Stolze, Leon A Rinkel, Mirjam R Heldner, Madlaine Müller, Marcel Arnold, Pasquale Mordasini, Jan Gralla, Philipp Baumgartner, Corinne Inauen, Laura P Westphal, Susanne Wegener, Patrik Michel, Simon Trüssel, Laura Mannismäki, Nicolas Martinez-Majander, Sami Curtze, Georg Kägi, Livio Picchetto, Maria Luisa Dell'Acqua, Guido Bigliardi, Christoph Riegler, Christian H Nolte, Miguel Serôdio, Miguel Miranda, João Pedro Marto, Andrea Zini, Stefano Forlivesi, Luana Gentile, Carlo W Cereda, Alessandro Pezzini, Ronen R Leker, Asaf Honig, Ivana Berisavac, Visnja Padjen, Marialuisa Zedde, Laurien S Kuhrij, Renske M Van den Berg-Vos, Stefan T Engelter, Henrik Gensicke, Paul J Nederkoorn","doi":"10.1177/23969873241277437","DOIUrl":"https://doi.org/10.1177/23969873241277437","url":null,"abstract":"<p><strong>Introduction: </strong>After positive findings in clinical trials the time window for endovascular thrombectomy (EVT) for patients with an acute ischemic stroke has been expanded up to 24 h from symptom onset or last seen well (LSW). We aimed to compare EVT patients' characteristics and outcomes in the early versus extended time window and to compare outcomes with the DAWN and DEFUSE 3 trial results.</p><p><strong>Patients and methods: </strong>Consecutive EVT patients from 16 mostly European comprehensive stroke centers from the EVA-TRISP cohort were included. We compared rates of 90-day good functional outcomes (Modified Rankin Scale 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality between patients treated in the early (<6 h after onset or LSW) versus extended (6-24 h after onset or LSW) time windows.</p><p><strong>Results: </strong>We included 9313 patients, of which 6876 were treated in the early and 2437 in the extended time window. National Institutes of Health Stroke Scale (NIHSS) score at presentation was lower in patients treated in the extended time window (median 13 [IQR 7-18] vs 15 [IQR 9-19], <i>p</i> < 0.001). The percentage of patients with good functional outcome was slightly lower in the extended time window (37.4% vs 42.2%, <i>p</i> < 0.001). However, rates of successful recanalization, sICH, and mortality were similar. Good functional outcome rates after EVT were slightly lower for patients in the extended window in the EVA-TRISP cohort as compared to DAWN and DEFUSE 3.</p><p><strong>Discussion and conclusion: </strong>According to this large multicenter cohort study reflecting daily clinical practice, EVT use in the extended time window appears safe and effective.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Atherosclerosis in patients with cervical artery dissection. 颈动脉夹层患者的动脉粥样硬化。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-04 DOI: 10.1177/23969873241274547
Eveline Brunner, Josefin E Kaufmann, Sandro Fischer, Henrik Gensicke, Annaelle Zietz, Alexandros A Polymeris, Valerian L Altersberger, Philippe A Lyrer, Christopher Traenka, Stefan T Engelter

Introduction: Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.

Patients and methods: Single-center exploratory study from the Stroke Center Basel, Switzerland. We re-reviewed duplex ultrasound images at (i) baseline and (ii) last follow-up visit for the presence versus absence of the following atherosclerotic manifestations in the carotid arteries: (i) abnormal carotid intima-media thickness, (ii) plaques, and (iii) atherosclerotic stenosis. We investigated whether CeAD patients with versus without co-existing atherosclerosis differ regarding (a) recurrence of CeAD and (b) occurrence of vascular events (myocardial infarction, peripheral artery disease, or ischemic stroke) using logistic regression with adjustment for age and follow-up time.

Results: Among 294 CeAD patients (median age 46 [IQR 37-53], 41.8% women), 35 (12%) had any atherosclerotic signs at baseline. Among 196 patients with available follow-up, another 21/196 (11%) patients developed atherosclerosis during a median follow-up of 55.7 months. Patients with atherosclerosis had decreased odds of recurrent CeADs when compared to patients without atherosclerosis (OR 0.03, 95% CI = 0.00-0.30). During follow-up, 6 (15%) vascular events occurred among 40 CeAD patients with atherosclerosis and 13 (8.5%) among 153 patients without atherosclerosis (OR 1.38, 95% CI = 0.39-4.55, data for 3 patients were missing).

Discussion and conclusion: Signs of atherosclerosis in the carotid artery were detectable in 12% of CeAD patient at baseline. Additionally, 11% of CeAD patients developed new signs of atherosclerosis within the following 5 years. The presence of atherosclerosis may suggest a lower risk for recurrent CeAD. Whether it might indicate an increased risk for late clinical vascular events deserves further studies.

简介颈动脉夹层(CeAD)被认为是一种非动脉粥样硬化性动脉病变,但颈动脉可能同时存在动脉粥样硬化。我们探讨了CeAD患者并存动脉粥样硬化的频率和临床重要性:瑞士巴塞尔卒中中心的单中心探索性研究。我们重新审查了(i)基线和(ii)最后一次随访时的双工超声图像,以确定颈动脉是否存在以下动脉粥样硬化表现:(i)颈动脉内膜-中层厚度异常、(ii)斑块和(iii)动脉粥样硬化性狭窄。我们通过调整年龄和随访时间的逻辑回归方法,研究了合并动脉粥样硬化的 CeAD 患者与未合并动脉粥样硬化的 CeAD 患者在以下方面是否存在差异:(a) CeAD 复发率;(b) 血管事件(心肌梗死、外周动脉疾病或缺血性中风)的发生率:294 名 CeAD 患者(中位年龄 46 [IQR:37-53],41.8% 为女性)中,35 人(12%)在基线时有任何动脉粥样硬化迹象。在有随访记录的196名患者中,有21/196(11%)名患者在中位随访55.7个月期间出现了动脉粥样硬化。与无动脉粥样硬化的患者相比,有动脉粥样硬化的患者复发 CeAD 的几率较低(OR 0.03,95% CI = 0.00-0.30)。在随访期间,40 名有动脉粥样硬化的 CeAD 患者中发生了 6 起(15%)血管事件,153 名无动脉粥样硬化的患者中发生了 13 起(8.5%)血管事件(OR 1.38,95% CI = 0.39-4.55,3 名患者数据缺失):讨论与结论:12%的CeAD患者在基线时可检测到颈动脉粥样硬化的迹象。此外,11%的CeAD患者在随后的5年内出现了新的动脉粥样硬化迹象。动脉粥样硬化的存在可能意味着复发 CeAD 的风险较低。至于动脉粥样硬化是否会增加晚期临床血管事件的风险,还有待进一步研究。
{"title":"Atherosclerosis in patients with cervical artery dissection.","authors":"Eveline Brunner, Josefin E Kaufmann, Sandro Fischer, Henrik Gensicke, Annaelle Zietz, Alexandros A Polymeris, Valerian L Altersberger, Philippe A Lyrer, Christopher Traenka, Stefan T Engelter","doi":"10.1177/23969873241274547","DOIUrl":"https://doi.org/10.1177/23969873241274547","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.</p><p><strong>Patients and methods: </strong>Single-center exploratory study from the Stroke Center Basel, Switzerland. We re-reviewed duplex ultrasound images at (i) baseline and (ii) last follow-up visit for the presence versus absence of the following atherosclerotic manifestations in the carotid arteries: (i) abnormal carotid intima-media thickness, (ii) plaques, and (iii) atherosclerotic stenosis. We investigated whether CeAD patients with versus without co-existing atherosclerosis differ regarding (a) recurrence of CeAD and (b) occurrence of vascular events (myocardial infarction, peripheral artery disease, or ischemic stroke) using logistic regression with adjustment for age and follow-up time.</p><p><strong>Results: </strong>Among 294 CeAD patients (median age 46 [IQR 37-53], 41.8% women), 35 (12%) had any atherosclerotic signs at baseline. Among 196 patients with available follow-up, another 21/196 (11%) patients developed atherosclerosis during a median follow-up of 55.7 months. Patients with atherosclerosis had decreased odds of recurrent CeADs when compared to patients without atherosclerosis (OR 0.03, 95% CI = 0.00-0.30). During follow-up, 6 (15%) vascular events occurred among 40 CeAD patients with atherosclerosis and 13 (8.5%) among 153 patients without atherosclerosis (OR 1.38, 95% CI = 0.39-4.55, data for 3 patients were missing).</p><p><strong>Discussion and conclusion: </strong>Signs of atherosclerosis in the carotid artery were detectable in 12% of CeAD patient at baseline. Additionally, 11% of CeAD patients developed new signs of atherosclerosis within the following 5 years. The presence of atherosclerosis may suggest a lower risk for recurrent CeAD. Whether it might indicate an increased risk for late clinical vascular events deserves further studies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry. 急性基底动脉闭塞症的预后和无症状颅内出血:PC-SEARCH血栓切除登记分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-25 DOI: 10.1177/23969873241234713
Adam T Mierzwa, Ashley Nelson, Sami Al Kasab, Santiago Ortega Gutierrez, Juan Vivanco-Suarez, Mudassir Farooqui, Ashutosh P Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Thanh N Nguyen, Piers Klein, Mohamad Abdalkader, Hisham Salahuddin, Aditya Pandey, Zachary Wilseck, Sravanthi Koduri, Niraj Vora, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Hisham Al-Hajala, Julie Shawver, Syed Zaidi, Mouhammad Jumaa

Introduction: Recent randomized controlled trials demonstrated superiority of mechanical thrombectomy compared to medical therapy in acute basilar artery occlusions, however, little data is available to guide clinicians in functional prognosis and risk stratification.

Patients and methods: Data from the retrospectively established PC-SEARCH Thrombectomy registry, which included patients with basilar artery occlusion from eight sites from January 2015 to December 2021, was interrogated. Outcomes were dichotomized into 90-day favorable (mRS ⩽ 3) and unfavorable (mRS > 3). Multivariate logistic regression analysis was performed with respect to the outcome groups and were adjusted for potential confounding baseline characteristics.

Results: Four-hundred-forty-four patients were included in this analysis. Mean age was 66 [SD 15], with 56% male, and comprised of 76% Caucasian. Patients presented with an initial median NIHSS of 18 and 199 patients (44.8%) achieved favorable 90-day functional outcomes. Independent predictors of favorable outcomes included younger age, pc-ASPECTS > 8 (OR 2.30 p < 0.001), and TICI ⩾ 2b (OR 7.56 p < 0.001). Unfavorable outcomes were associated with increasing number of passes (OR 1.29 p = 0.004) and sICH (OR 4.19 p = 0.015). IA-tPA was an independent risk factor for sICH (OR 7.15 p = 0.002) without improving favorable functional outcomes.

Conclusion and discussion: PC-ASPECTS > 8, successful recanalization (TICI ⩾ 2b), first-pass recanalization, and younger age are independent predictors of favorable 90-day functional outcome in thrombectomy treated patients with acute basilar artery occlusion. Conversely, sICH were independent predictors of unfavorable outcomes. IA-tPA and unsuccessful recanalization are independently associated with sICH.

简介:最近的随机对照试验表明,在急性基底动脉闭塞症中,机械性血栓切除术优于药物治疗,然而,几乎没有数据可用于指导临床医生进行功能性预后和风险分层:研究人员查询了回顾性建立的 PC-SEARCH 血栓切除术登记处的数据,该登记处纳入了 2015 年 1 月至 2021 年 12 月期间来自 8 个地点的基底动脉闭塞患者。结果分为90天良好(mRS ⩽3)和不良(mRS > 3)。对结果分组进行了多变量逻辑回归分析,并对潜在的混杂基线特征进行了调整:本次分析共纳入了 44 名患者。平均年龄为 66 岁 [SD 15],男性占 56%,白种人占 76%。患者最初的 NIHSS 中位数为 18,199 名患者(44.8%)获得了良好的 90 天功能预后。良好预后的独立预测因素包括年龄较小、pc-ASPECTS > 8(OR 2.30 p p = 0.004)和sICH(OR 4.19 p = 0.015)。IA-tPA是导致sICH的独立危险因素(OR 7.15 p = 0.002),但不会改善良好的功能预后:结论:PC-ASPECTS > 8、成功再通畅(TICI ⩾2b)、首次再通畅和年龄较小是血栓切除术治疗急性基底动脉闭塞患者 90 天功能预后良好的独立预测因素。相反,sICH 则是不良预后的独立预测因素。IA-tPA和不成功的再通与sICH独立相关。
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引用次数: 0
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European Stroke Journal
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