Comparing Outcomes of Thrombectomy Versus Intravenous Thrombolysis Based on Middle Cerebral Artery M2 Occlusion Features

被引：5

作者：

Zhou, Huan ^{[1
]}

Zhong, Wansi ^{[1
]}

Zhang, Tingxia ^{[1
]}

Xu, Chenghua ^{[2
]}

Zhong, Genlong ^{[3
]}

Xie, Guomin ^{[4
]}

Zhang, Bing ^{[5
]}

Chen, Hongfang ^{[6
]}

Wang, En ^{[7
]}

Xu, Dongjuan ^{[8
]}

Cheng, Chaochan ^{[9
]}

Yang, Jiansheng ^{[1
]}

Lou, Min ^{[1
]}

Yan, Shenqiang ^{[1
]}

机构：

[1] Zhejiang Univ, Affiliated Hosp 2, Sch Med, Dept Neurol, 88 Jiefang Rd, Hangzhou, Peoples R China

[2] Taizhou First Peoples Hosp, Dept Neurol, Taizhou, Peoples R China

[3] Wenzhou Med Univ, Affiliated Hosp 6, Peoples Hosp Lishui, Dept Neurol, Lishui, Peoples R China

[4] Li Huili Hosp, Ningbo Med Ctr, Dept Neurol, Ningbo, Peoples R China

[5] Huzhou Cent Hosp, Dept Neurol, Huzhou, Peoples R China

[6] Zhejiang Univ, Sch Med, Jinhua Hosp, Dept Neurol, Jinhua, Peoples R China

[7] Wenzhou Med Univ, Taizhou Hosp Zhejiang Prov, Dept Neurol, Linhai, Peoples R China

[8] Wenzhou Med Univ, Dongyang Affiliated Hosp, Dept Neurol, Dongyang, Peoples R China

[9] First Peoples Hosp Yongkang, Dept Neurol, Yongkang, Peoples R China

来源：

STROKE | 2024年 / 55卷 / 06期

基金：

中国国家自然科学基金;

关键词：

cerebrovascular occlusion; ischemic stroke; outcome assessment; thrombectomy; thrombolytic therapy; ACUTE ISCHEMIC-STROKE; ENDOVASCULAR THERAPY; CONSCIOUS SEDATION; GENERAL-ANESTHESIA; CLASSIFICATION; REPERFUSION; GUIDELINES; SEGMENT; ONSET;

D O I：

10.1161/STROKEAHA.123.044986

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: Current evidence provides limited support for the superiority of endovascular thrombectomy (EVT) in patients with M2 segment middle cerebral artery occlusion. We aim to investigate whether imaging features of M2 segment occlusion impact the effectiveness of EVT. METHODS: We conducted a retrospective cohort study from January 2017 to January 2022, drawing data from the CASE II registry (Computer-Based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation), which specifically documented patients with acute ischemic stroke presenting with M2 segment occlusion undergoing reperfusion therapy. Patients were stratified into the intravenous thrombolysis (IVT) group (IVT alone) and EVT group (IVT plus EVT or EVT alone). The primary outcome was a modified Rankin Scale score 0 to 2 at 90 days. Secondary outcomes included additional thresholds and distribution of modified Rankin Scale scores, 24-hour recanalization, early neurological deterioration, and relevant complications during hospitalization. Safety outcomes encompassed intracranial hemorrhagic events at 24 hours and mortality at 90 days. Binary logistic regression analyses with propensity score matching were used. Subgroup analyses were performed based on the anatomic site of occlusion, including right versus left, proximal versus distal, dominant/co-dominant versus nondominant, single versus double/triple branch(es), and anterior versus central/posterior branch. RESULTS: Among 734 patients (43.3% were females; median age, 73 years) with M2 segment occlusion, 342 (46.6%) were in the EVT group. Propensity score matching analysis revealed no statistical difference in the primary outcome (odds ratio, 0.860 [95% CI, 0.611-1.209]; P=0.385) between the EVT group and IVT group. However, EVT was associated with a higher incidence of subarachnoid hemorrhage (odds ratio, 6.655 [95% CI, 1.487-29.788]; P=0.004) and pneumonia (odds ratio, 2.015 [95% CI, 1.364-2.977]; P<0.001). Subgroup analyses indicated that patients in the IVT group achieved better outcomes when presenting with right, distal, or nondominant branch occlusion (P-all interaction<0.05). CONCLUSIONS: Our study showed similar efficiency of EVT versus IVT alone in acute M2 segment middle cerebral artery occlusion. This suggested that only specific patient subpopulations might have a potentially higher benefit of EVT over IVT alone.

引用

页码：1592 / 1600

页数：9

共 28 条

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← 1 2 3 →

共 28 条

[1] CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].

ADAMS, HP ;

BENDIXEN, BH ;

KAPPELLE, LJ ;

BILLER, J ;

LOVE, BB ;

GORDON, DL ;

MARSH, EE ;

KASE, CS ;

WOLF, PA ;

BABIKIAN, VL ;

LICATAGEHR, EE ;

ALLEN, N ;

BRASS, LM ;

FAYAD, PB ;

PAVALKIS, FJ ;

WEINBERGER, JM ;

TUHRIM, S ;

RUDOLPH, SH ;

HOROWITZ, DR ;

BITTON, A ;

MOHR, JP ;

SACCO, RL ;

CLAVIJO, M ;

ROSENBAUM, DM ;

SPARR, SA ;

KATZ, P ;

KLONOWSKI, E ;

CULEBRAS, A ;

CAREY, G ;

MARTIR, NI ;

FICARRA, C ;

HOGAN, EL ;

CARTER, T ;

GURECKI, P ;

MUNTZ, BK ;

RAMIREZLASSEPAS, M ;

TULLOCH, JW ;

QUINONES, MR ;

MENDEZ, M ;

ZHANG, SM ;

ALA, T ;

JOHNSTON, KC ;

ANDERSON, DC ;

TARREL, RM ;

NANCE, MA ;

BUDLIE, SR ;

DIERICH, M ;

HELGASON, CM ;

HIER, DB ;

SHAPIRO, RA .

STROKE, 1993, 24 (01) :35-41

[2] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[3] Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis [J].

Alexandre, Andrea M. ;

Colo, Francesca ;

Brunetti, Valerio ;

Valente, Iacopo ;

Frisullo, Giovanni ;

Pedicelli, Alessandro ;

Scarcia, Luca ;

Rollo, Claudia ;

Falcou, Anne ;

Milonia, Luca ;

Andrighetti, Marco ;

Piano, Mariangela ;

Macera, Antonio ;

Commodaro, Christian ;

Ruggiero, Maria ;

Da Ros, Valerio ;

Bellini, Luigi ;

Lazzarotti, Guido A. ;

Cosottini, Mirco ;

Caragliano, Armando A. ;

Vinci, Sergio L. ;

Gabrieli, Joseph D. ;

Causin, Francesco ;

Panni, Pietro ;

Roveri, Luisa ;

Limbucci, Nicola ;

Arba, Francesco ;

Pileggi, Marco ;

Bianco, Giovanni ;

Romano, Daniele G. ;

Diana, Francesco ;

Semeraro, Vittorio ;

Burdi, Nicola ;

Ganimede, Maria P. ;

Lozupone, Emilio ;

Fasano, Antonio ;

Lafe, Elvis ;

Cavallini, Anna ;

Russo, Riccardo ;

Bergui, Mauro ;

Calabresi, Paolo ;

Della Marca, Giacomo ;

Broccolini, Aldobrando .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2023, 15 (E2) :E198-E203

[4] General anesthesia versus conscious sedation for endovascular therapy in acute ischemic stroke: A systematic review and meta-analysis [J].

Bai, Xuesong ;

Zhang, Xiao ;

Wang, Tao ;

Feng, Yao ;

Wang, Yan ;

Lyu, Xiajie ;

Yang, Kun ;

Wang, Xue ;

Song, Haiqing ;

Ma, Qingfeng ;

Ma, Yan ;

Jiao, Liqun .

JOURNAL OF CLINICAL NEUROSCIENCE, 2021, 86 :10-17

[5] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[6] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[7] Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke [J].

Compagne, Kars C. J. ;

van der Sluijs, Pieter M. ;

van den Wijngaard, Ido R. ;

Roozenbeek, Bob ;

Mulder, Maxim J. H. L. ;

van Zwam, Wim H. ;

Emmer, Bart J. ;

Majoie, Charles B. L. M. ;

Yoo, Albert J. ;

Nijeholt, Geert J. Lycklama A. ;

Lingsma, Hester F. ;

Dippel, Diederik W. J. ;

van der Lugt, Aad ;

van Es, Adriaan C. G. M. ;

Roos, Yvo B. W. E. M. ;

van Oostenbrugge, Robert J. ;

Boiten, Jelis ;

Vos, Jan Albert ;

Jansen, Ivo G. H. ;

Goldhoorn, Robert-Jan B. ;

Schonewille, Wouter J. ;

Coutinho, Jonathan M. ;

Wermer, Marieke J. H. ;

van Walderveen, Marianne A. A. ;

Staals, Julie ;

Hofmeijer, Jeannette ;

Martens, Jasper M. ;

de Bruijn, Sebastiaan F. ;

van Dijk, Lukas C. ;

van der Worp, H. Bart ;

Lo, Rob H. ;

van Dijk, Ewoud J. ;

Boogaarts, Hieronymus D. ;

de Kort, Paul L. M. ;

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