{"title":"颅内动脉粥样硬化疾病机制预示着大血管闭塞性急性脑梗死血栓切除术的不良后果:匹配队列研究","authors":"","doi":"10.1016/j.jns.2024.123235","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Thrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission.</p></div><div><h3>Methods</h3><p>This retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups.</p></div><div><h3>Results</h3><p>The study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, <em>p</em> = 0.001), and longer procedural times (median 88 min vs. 50 min, <em>p</em> < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, <em>p</em> = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148–12.603; <em>p</em> = 0.029).</p></div><div><h3>Conclusion</h3><p>In thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intracranial atherosclerotic disease mechanism indicates poor outcomes of thrombectomy in acute cerebral infarction with large vessel occlusion: A matched cohort study\",\"authors\":\"\",\"doi\":\"10.1016/j.jns.2024.123235\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Thrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission.</p></div><div><h3>Methods</h3><p>This retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups.</p></div><div><h3>Results</h3><p>The study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, <em>p</em> = 0.001), and longer procedural times (median 88 min vs. 50 min, <em>p</em> < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, <em>p</em> = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148–12.603; <em>p</em> = 0.029).</p></div><div><h3>Conclusion</h3><p>In thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.</p></div>\",\"PeriodicalId\":17417,\"journal\":{\"name\":\"Journal of the Neurological Sciences\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-09-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Neurological Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022510X24003708\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Neurological Sciences","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022510X24003708","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Intracranial atherosclerotic disease mechanism indicates poor outcomes of thrombectomy in acute cerebral infarction with large vessel occlusion: A matched cohort study
Background
Thrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission.
Methods
This retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups.
Results
The study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, p = 0.001), and longer procedural times (median 88 min vs. 50 min, p < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, p = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148–12.603; p = 0.029).
Conclusion
In thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.
期刊介绍:
The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials).
JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.