Reperfusion Treatments in Disabling Versus Nondisabling Mild Stroke due to Anterior Circulation Vessel Occlusion

被引：9

作者：

Schwarz, Ghil ^{[1
,2
,3
,4
]}

Cascio Rizzo, Angelo ^{[2
,3
]}

Matusevicius, Marius ^{[5
,6
]}

Giussani, Giuditta ^{[2
,3
,7
]}

Invernizzi, Paolo ^{[8
]}

Melis, Fabio ^{[9
,10
]}

Lesko, Norbert ^{[11
]}

Toni, Danilo ^{[12
]}

Agostoni, Elio Clemente ^{[2
,3
]}

Ahmed, Niaz ^{[5
,6
]}

机构：

[1] ASST Grande Osped Metropolitano Niguarda, Dept Neurol, Stroke Unit, Piazza Osped Maggiore 3, I-20162 Milan, Italy

[2] ASST Grande Osped Metropolitano Niguarda, Dept Neurol, Milan, Italy

[3] ASST Grande Osped Metropolitano Niguarda, Stroke Unit, Milan, Italy

[4] UCL, Inst Neurol, Stroke Res Ctr, London, England

[5] Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden

[6] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[7] Osped San Giuseppe Multimed IRCCS, Dept Neurol, Stroke Unit, Milan, Italy

[8] Ist Osped Fdn Poliambulanza, Neuroradiol Unit, Brescia, Italy

[9] Ist Osped Fdn Poliambulanza, Neurol Unit, Brescia, Italy

[10] Osped Maria Vittoria, ASL Citta di Torino, SS Neurovasc, Turin, Italy

[11] Safarik Univ, Dept Neurol, Kosice, Slovakia

[12] Sapienza Univ Rome, Emergency Dept Stroke Unit, Dept Human Neurosci, Rome, Italy

来源：

STROKE | 2023年 / 54卷 / 03期

关键词：

intracranial hemorrhage; propensity score; reperfusion; stroke; thrombectomy; ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; GUIDELINES; ALTEPLASE; OUTCOMES; THERAPY;

D O I：

10.1161/STROKEAHA.122.041772

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background:The benefit of distinguishing between disabling versus nondisabling deficit in mild acute ischemic stroke due to endovascular thrombectomy-targetable vessel occlusion (EVT-tVO; including anterior circulation large and medium-vessel occlusion) is unknown. We compared safety and efficacy of acute reperfusion treatments in disabling versus nondisabling mild EVT-tVO. Methods:From the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register, we included consecutive acute ischemic stroke patients (2015-2021) treated within 4.5 hours, with full NIHSS items availability and score <= 5, evidence of intracranial internal carotid artery, M1, A1-2, or M2-3 occlusion. After propensity score matching, we compared efficacy (3-month modified Rankin Scale score of 0-1, modified Rankin Scale score of 0-2, and early neurological improvement) and safety (nonhemorrhagic early neurological deterioration, any intracerebral or subarachnoid hemorrhage, symptomatic intracranial hemorrhage, and death at 3-month) outcomes in disabling versus nondisabling patients-adopting an available definition. Results:We included 1459 patients. Propensity score matched analysis of disabling versus nondisabling EVT-tVO (n=336 per group) found no significant differences in efficacy (modified Rankin Scale score 0-1: 67.4% versus 71.5%, P=0.336; modified Rankin Scale score 0-2: 77.1% versus 77.6%, P=0.895; early neurological improvement: 38.3% versus 44.4%, P=0.132) and safety (nonhemorrhagic early neurological deterioration: 8.5% versus 8.0%, P=0.830; any intracerebral hemorrhage or subarachnoid hemorrhage: 12.5% versus 13.3%, P=0.792; symptomatic intracranial hemorrhage: 2.6% versus 3.4%, P=0.598; and 3-month death: 9.8% versus 9.2%, P=0.844) outcomes. Conclusions:We found similar safety and efficacy outcomes after acute reperfusion treatment in disabling versus nondisabling mild EVT-tVO; our findings suggest to adopt similar acute treatment approaches in the 2 groups. Randomized data are needed to clarify the best reperfusion treatment in mild EVT-tVO.

引用

页码：743 / 750

页数：8

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