Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

被引：10

作者：

Todo, Kenichi ^{[1
,2
]}

Sakai, Nobuyuki ^{[1
]}

Imamura, Hirotoshi ^{[1
]}

Yamagami, Hiroshi ^{[1
,3
]}

Adachi, Hidemitsu ^{[1
]}

Kono, Tomoyuki ^{[1
]}

Kobayashi, Junya ^{[1
,4
]}

Yamamoto, Shiro ^{[1
,5
]}

Morimoto, Takeshi ^{[6
]}

Tani, Shoichi ^{[1
]}

Kawamoto, Michi ^{[1
]}

Sakaguchi, Manabu ^{[1
,2
]}

Ueno, Yasushi ^{[1
,7
]}

Kunieda, Takeharu ^{[1
,8
]}

Narumi, Osamu ^{[1
,9
]}

Sakai, Chiaki ^{[1
]}

Ishii, Akira ^{[1
,10
]}

Hoshi, Taku ^{[1
,11
]}

Koyanagi, Masaomi ^{[1
,9
]}

Mineharu, Yohei ^{[1
,10
]}

Ishikawa, Tatsuya ^{[1
,12
]}

Kuramoto, Yoji ^{[1
,13
]}

Sato, Shinsuke ^{[1
,14
]}

Ohara, Nobuyuki ^{[1
,4
]}

Arimura, Koichi ^{[1
,15
]}

Nakamura, Hajime ^{[2
]}

Nishida, Takeo ^{[2
]}

Gon, Yasufumi ^{[2
]}

Fujinaka, Toshiyuki ^{[2
,16
]}

Yoshiya, Kazuhisa ^{[2
]}

Kishima, Haruhiko ^{[2
]}

Mochizuki, Hideki ^{[2
]}

Kohara, Nobuo ^{[1
]}

机构：

[1] Kobe City Med Ctr Gen Hosp, Comprehens Stroke Ctr, Kobe, Hyogo, Japan

[2] Osaka Univ, Grad Sch Med, Stroke Ctr, Osaka, Japan

[3] Natl Cerebral & Cardiovasc Ctr, Div Stroke Care Unit, Suita, Osaka, Japan

[4] Natl Hosp Org Osaka, Dept Vasc Neurol, Minami Med Ctr, Osaka, Japan

[5] Natl Hosp Org Osaka Med Ctr, Div Stroke Med, Osaka, Japan

[6] Hyogo Coll Med, Dept Clin Epidemiol, Nishinomiya, Hyogo, Japan

[7] Shinko Mem Hosp, Dept Neurosurg, Kobe, Hyogo, Japan

[8] Ehime Univ, Dept Neurosurg, Sch Med, Matsuyama, Ehime, Japan

[9] Amagasaki Gen Med Ctr, Dept Neurosurg, Amagasaki, Hyogo, Japan

[10] Kyoto Univ, Grad Sch Med, Dept Neurosurg, Kyoto, Japan

[11] Osaka Gen Med Ctr, Dept Neurol, Osaka, Japan

[12] Tokyo Womens Med Univ, Dept Neurosurg, Tokyo, Japan

[13] Hyogo Coll Med, Dept Neurosurg, Nishinomiya, Hyogo, Japan

[14] St Lukes Int Hosp, Dept Neurosurg & Neurovasc Therapy, Tokyo, Japan

[15] Kyushu Univ, Grad Sch Med Sci, Dept Neurosurg, Fukuoka, Fukuoka, Japan

[16] Natl Hosp Org Osaka Med Ctr, Dept Neurosurg, Osaka, Japan

来源：

CEREBROVASCULAR DISEASES | 2019年 / 47卷 / 3-4期

关键词：

Acute interventional treatment; Ischemic stroke; Long-term outcome; Outcome; ACUTE ISCHEMIC-STROKE; FOLLOW-UP; THROMBECTOMY; TRIAL; THROMBOLYSIS; METAANALYSIS; ALTEPLASE;

D O I：

10.1159/000499190

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: Recent studies have demonstrated that endovascular reperfusion therapy improves clinical outcomes at 90 days after ischemic stroke. However, the effects on long-term outcomes are not well known. We hypothesized that successful reperfusion might be associated with long-term improvement beyond 90 days after endovascular therapy. To assess the long-term effects beyond 90 days, we analyzed the association of successful reperfusion with a temporal change in modified Rankin Scale (mRS) score from 90 days to 1 year after endovascular therapy. Methods: We retrospectively analyzed a database of consecutive patients with acute ischemic stroke who received endovascular therapy between April 2006 and March 2016 at 4 centers. We compared the incidences of improvement and deterioration in patients with successful reperfusion (i.e., modified thrombolysis in cerebral infarction score of 2b or 3) with those in patients with unsuccessful reperfusion. We defined improvement and deterioration as decrease and increase on the mRS score by 1 point or more from 90 days to 1 year after endovascular therapy respectively. Results: A total of 268 patients were included in the current study. The rate of patients with improvement tended to be higher in patients with successful reperfusion than in patients with unsuccessful reperfusion (20% [34/167 patients] vs. 12% [12/101], p = 0.07). The rate of patients with deterioration was lower in patients with successful reperfusion than in patients with unsuccessful reperfusion (25% [42/167] vs. 42% [42/101], p < 0.01). After adjustment for confounders, successful reperfusion was associated with improvement (adjusted OR 2.65; 95% CI 1.23-5.73; p < 0.05) and deterioration (adjusted OR 0.33; 95% CI 0.18-0.62; p < 0.01), independent of the 90-day mRS score. Conclusions: Successful reperfusion has further beneficial legacy effects on long-term outcomes beyond 90 days after stroke.

引用

页码：127 / 134

页数：8

共 20 条

[1] Early administration of tissue-plasminogen activator improves the long-term clinical outcome at 5 years after onset [J].

Aoki, Junya ;

Kimura, Kazumi ;

Sakamoto, Yuki .

JOURNAL OF THE NEUROLOGICAL SCIENCES, 2016, 362 :33-39

[2] 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

[3] 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

[4] Intravenous thrombolysis and three-year ischemic stroke mortality [J].

Chwojnicki, K. ;

Kozera, G. ;

Sobolewski, P. ;

Fryze, W. ;

Nyka, W. M. .

ACTA NEUROLOGICA SCANDINAVICA, 2017, 135 (05) :540-545

[5] Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial [J].

Davalos, Antoni ;

Cobo, Erik ;

Molina, Carlos A. ;

Chamorro, Angel ;

Angeles de Miquel, M. ;

San Roman, Luis ;

Serena, Joaquin ;

Lopez-Cancio, Elena ;

Ribo, Marc ;

Millan, Monica ;

Urra, Xabier ;

Cardona, Pere ;

Tomasello, Alejandro ;

Castano, Carlos ;

Blasco, Jordi ;

Aja, Lucia ;

Rubiera, Marta ;

Gomis, Meritxell ;

Renu, Arturo ;

Lara, Blanca ;

Marti-Fabregas, Joan ;

Jankowitz, Brian ;

Cerda, Neus ;

Jovin, Tudor G. .

LANCET NEUROLOGY, 2017, 16 (05) :369-376

[6] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[7] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

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

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[8] Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) [J].

Hacke, W ;

Kaste, M ;

Fieschi, C ;

von Kummer, R ;

Davalos, A ;

Meier, D ;

Larrue, V ;

Bluhmki, E ;

Davis, S ;

Donnan, G ;

Schneider, D ;

Diez-Tejedor, E ;

Trouillas, P .

LANCET, 1998, 352 (9136) :1245-1251

[9] The immunology of stroke: from mechanisms to translation [J].

Iadecola, Costantino ;

Anrather, Josef .

NATURE MEDICINE, 2011, 17 (07) :796-808

[10] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

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