Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity

被引：57

作者：

Lee, Sang-Hwa ^{[1
]}

Kim, Beom Joon ^{[2
]}

Han, Moon-Ku ^{[2
]}

Park, Tai Hwan ^{[3
]}

Lee, Kyung Bok ^{[4
]}

Lee, Byung-Chul ^{[5
]}

Yu, Kyung-Ho ^{[5
]}

Oh, Mi Sun ^{[5
]}

Cha, Jae Kwan ^{[6
]}

Kim, Dae-Hyun ^{[6
]}

Nah, Hyun-Wook ^{[6
]}

Lee, Jun ^{[7
]}

Lee, Soo Joo ^{[8
]}

Kim, Jae Guk ^{[8
]}

Park, Jong-Moo ^{[9
]}

Kang, Kyusik ^{[9
]}

Cho, Yong-Jin ^{[10
]}

Hong, Keun-Sik ^{[10
]}

Park, Hong-Kyun ^{[10
]}

Choi, Jay Chol ^{[11
]}

Kim, Joon-Tae ^{[12
]}

Choi, Kangho ^{[12
]}

Kim, Dong-Eog ^{[13
]}

Ryu, Wi-Sun ^{[13
]}

Kim, Wook-Joo ^{[14
]}

Shin, Dong-Ick ^{[15
]}

Yeo, Minju ^{[15
]}

Sohn, Sung-Il ^{[16
]}

Hong, Jeong-Ho ^{[16
]}

Lee, Juneyoung ^{[17
]}

Lee, Ji Sung ^{[18
]}

Khatri, Pooja ^{[19
]}

Bae, Hee-Joon ^{[2
]}

机构：

[1] Hallym Univ, Chuncheon Sacred Heart Hosp, Dept Neurol, Chunchon, South Korea

[2] Seoul Natl Univ, Bundang Hosp, Dept Neurol, Seongnam, South Korea

[3] Seoul Med Ctr, Dept Neurol, Seoul, South Korea

[4] Soonchunhyang Univ, Coll Med, Dept Neurol, Seoul, South Korea

[5] Hallym Univ, Sacred Heart Hosp, Dept Neurol, Anyang, South Korea

[6] Dong A Univ Hosp, Dept Neurol, Pusan, South Korea

[7] Yeungnam Univ, Med Ctr, Dept Neurol, Daegu, South Korea

[8] Eulji Univ, Eulji Univ Hosp, Sch Med, Dept Neurol, Daejeon, South Korea

[9] Eulji Univ, Eulji Gen Hosp, Dept Neurol, Seoul, South Korea

[10] Inje Univ, Ilsan Paik Hosp, Dept Neurol, Goyang, South Korea

[11] Jeju Natl Univ, Dept Neurol, Jeju, South Korea

[12] Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South Korea

[13] Dongguk Univ Ilsan Hosp, Dept Neurol, Goyang, South Korea

[14] Univ Ulsan, Ulsan Univ Hosp, Coll Med, Ulsan, South Korea

[15] Chungbuk Natl Univ, Coll Med, Dept Neurol, Cheongju, South Korea

[16] Keimyung Univ, Dongsan Med Ctr, Dept Neurol, Daegu, South Korea

[17] Korea Univ, Coll Med, Dept Biostat, Seoul, South Korea

[18] Asan Med Ctr, Clin Res Ctr, Seoul, South Korea

[19] Univ Cincinnati, Dept Neurol, Cincinnati, OH USA

来源：

BMC NEUROLOGY | 2019年 / 19卷 / 1期

关键词：

Futile reperfusion; Endovascular treatment; Stroke severity; Therapeutic benefit; ACUTE ISCHEMIC-STROKE; HEALTH-CARE PROFESSIONALS; INTRAVENOUS T-PA; SUCCESSFUL REVASCULARIZATION; INTRAARTERIAL TREATMENT; EARLY MANAGEMENT; THROMBECTOMY; RECANALIZATION; TIME; METAANALYSIS;

D O I：

10.1186/s12883-019-1237-2

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundFutile reperfusion (poor functional status despite successful reperfusion) was observed in up to 67% of patients enrolled in recent endovascular treatment (EVT) clinical trials. We investigated the impact of baseline stroke severity on both futile reperfusion and therapeutic benefit of successful EVT.MethodsUsing a prospective multicenter stroke registry, we identified consecutive ischemic stroke patients with anterior circulation large artery occlusion, who were reperfused successfully by EVT (Thrombolysis in Cerebral Infarction grade 2b-3). The rate of futile reperfusion was assessed across the initial National Institutes of Health Stroke Scale (NIHSS) scores. The frequency of poor outcomes (modified Rankin scale [mRS] 3-6) according to NIHSS scores was compared between patients revascularized successfully by EVT and those who did not receive EVT, after standardizing for age.ResultsAmong 21,591 patients with ischemic stroke, 972 (4.5%) received EVT within 12h of onset, including 440 who met study eligibility criteria. Futile reperfusion was observed in 226 of the 440 study-eligible patients (51.4%) and was associated with stroke severity: 20.9% in NIHSS scores 5, 34.6% in 6-10, 58.9% in 11-20, and 63.8% in >20 (p<0.001). Nonetheless, the therapeutic benefit of EVT also increased with increasing stroke severity (p for interaction <0.001): 0.1% in NIHSS 5, 18.6% in 6-10, 28.7% in 11-20, and 34.3% in >20.ConclusionsEVT is more beneficial with increasing stroke severity, although futile reperfusion also increases with higher stroke severity.

引用

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