急性脑卒中后动脉闭塞患者预后不良的预测因素及医疗管理。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2025-01-03 DOI:10.1177/17474930241309533
Candice Sabben, Frédérique Charbonneau, Michael Obadia, Davide Strambo, Elodie Ong, Mirjam R Heldner, Hilde Henon, Adrien Ter Schiphorst, Loïc Legris, Thomas Agasse-Lafont, Denis Sablot, Nour Nehme, Igor Sibon, Aude Triquenot-Bagan, Valérie Wolff, Cécile Preterre, Charlotte Rosso, Gioia Mione, Roxana Poll, Jérémie Papassin, Andreea Aignatoaie, David Weisenburger Lile, Yannick Béjot, Solène Moulin, Emmanuel Carrera, Pierre Garnier, Patrik Michel, Pasquale Mordasini, Gregory W Albers, Guillaume Turc, Mikael Mazighi, Pierre Seners
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引用次数: 0

摘要

背景和目的:急性缺血性脑卒中孤立性大脑后动脉近端闭塞(PCA)患者的临床进展仅通过药物治疗的报道很少。我们的目的是确定与这一人群中功能不良预后相关的临床和放射学因素。方法:我们在法国、瑞士和美国的26个卒中中心进行了一项多中心国际回顾性研究,研究对象是在症状出现后6小时内入院的连续卒中患者,这些患者均为PCA第一节(P1)或第二节(P2)孤立闭塞,并接受了最好的药物治疗。不良功能预后定义为3个月时改良Rankin量表(mRS)≥2或未恢复到卒中前mRS.。预处理变量与不良预后之间的关系通过单变量和多变量分析进行研究,以及不良预后与关键随访放射学变量之间的关系。结果:共纳入585例患者。中位年龄为74岁(IQR, 63-83),中位NIHSS为6岁(3-10),80%接受静脉溶栓(IVT), 22%和78%分别有P1和P2闭塞。56%的患者预后不良。在关注预处理变量的多变量分析中,年龄(调整后OR=1.12 / 5年)[95%CI 1.05-1.20];P=0.001), NIHSS评分(每增加1分aOR=1.12 [1.08-1.18];结论:半数以上经药物治疗的pca相关急性脑卒中患者预后不良。促进IVT的使用可能会改善功能预后。旨在加强再通和减少出血转化的治疗方法需要在临床试验中进行研究。
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Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.

Background and aims: The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.

Methods: We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6 h from symptoms onset in 26 stroke centers in France, Switzerland, and the United States, treated with the best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ⩾2 at 3 months or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable and then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.

Results: Overall, 585 patients were included. The median age was 74 years (interquartile range (IQR) = 63-83), median National Institutes of Health Stroke Scale (NIHSS) was 6 (3-10), 80% received intravenous thrombolysis (IVT), and 22% and 78% had P1 and P2 occlusions, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted odds ratio (OR) = 1.12 per 5-year increase [95% confidence interval (CI) = 1.05-1.20]; p = 0.001), NIHSS score (aOR = 1.12 per each point increase [1.08-1.18]; p < 0.001), infarct volume (aOR = 1.16 per 5 mL increase [1.07-1.25]; p < 0.001), and the lack of IVT use (aOR = 1.79 [1.10-2.94], p = 0.020) were independently associated with poor outcome. Regarding 24-h follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR = 0.37 [95% CI = 0.21-0.65], p < 0.001) and parenchymal hematoma occurrence (aOR = 2.37 [95% CI = 1.01-5.56], p = 0.048) were independently associated with poor 3-month outcome.

Conclusions: Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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