前驱症状对接受机械血栓切除术治疗的基底动脉闭塞患者预后的影响。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-02-25 DOI:10.1177/23969873241234844
Thomas Accettone, Thomas Personnic, Martin Bretzner, Helene Behal, Charlotte Cordonnier, Hilde Henon, Laurent Puy
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引用次数: 0

摘要

导言:即使采用再灌注疗法,基底动脉闭塞(BAO)相关中风患者的预后仍然很差。我们的目的是验证一个假设,即前驱症状的存在是功能预后不良的一个关键决定因素:我们前瞻性地收集了2015年至2021年间在法国里尔接受机械血栓切除术(MT)治疗的BAO患者的数据。前驱症状的定义是在继发性临床症状突然恶化之前出现的一过性神经功能缺损或渐进性临床症状恶化。我们比较了有前驱症状和无前驱症状患者的特征。我们建立了多变量逻辑回归模型,研究前驱症状的存在与功能性(mRS 0-3 和死亡率)和程序性(成功再通畅和早期再闭塞)结果之间的关系:在180名患者中,63人(35%)有前驱症状,最常见的是眩晕。大动脉粥样硬化是导致中风的主要原因(41.3%)。前驱症状是90天功能预后较差(mRS 0-3:25.4% vs 47.0%,几率比(OR)0.39;95% 置信区间(CI)0.16-0.86)和90天死亡率(OR 2.17;95% CI 1.02-4.65)的独立预测因素。尽管再通成功率相似,但有前驱症状的患者早期基底动脉再闭塞的比例更高(23.8% vs 5.6%,P = 0.002):超过三分之一接受 MT 治疗的 BAO 患者有前驱症状,尤其是大动脉粥样硬化患者。考虑到相关功能预后较差以及基底动脉早期再闭塞的风险增加,临床医生应系统筛查前驱症状。
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Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy.

Introduction: Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome.

Patients and methods: Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes.

Results: Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002).

Discussion and conclusion: More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
期刊最新文献
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