Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes.
Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes.
复制标题
尽管大血管闭塞中风成功进行血运重建，但功能依赖性的预测因素
DOI：
10.1161/strokeaha.114.005603
复制
发表时间：
2014-07
期刊：
影响因子：
8.3
通讯作者：
Multi MERCI, TREVO, and TREVO 2 Investigators
中科院分区：
文献类型：
--
作者：
Shi ZS;Liebeskind DS;Xiang B;Ge SG;Feng L;Albers GW;Budzik R;Devlin T;Gupta R;Jansen O;Jovin TG;Killer-Oberpfalzer M;Lutsep HL;Macho J;Nogueira RG;Rymer M;Smith WS;Wahlgren N;Duckwiler GR;Multi MERCI, TREVO, and TREVO 2 Investigators
机械取栓治疗大血管闭塞性卒中的高血运重建率并不总是与良好的临床结果相关。我们评估了急性缺血性脑卒中取栓治疗患者血运重建成功后功能依赖的预测因素。我们分析了脑缺血多机械栓塞去除（MERCI）、急性缺血性卒中大血管闭塞取栓重建术（TREVO）和TREVO 2试验的汇总数据。血运重建成功定义为脑梗死评分为2b或3分的溶栓。功能依赖的定义是3个月时在修正兰金量表上得分为3到6分。我们评估了人口统计学、临床、血管造影特征和出血与成功血运重建后功能依赖的关系。228例血运重建成功的患者进行了临床结果随访。功能依赖与血管内成功的比率，Trevo取栓为48.6%，Merci取栓为58.0%。年龄（优势比1.04,95%可信区间，每1年增加1.02-1.06）、美国国立卫生研究院卒中量表评分（优势比1.08,95%可信区间，每1点增加1.02-1.15）、症状发作到血管内治疗时间（优势比1.11,95%可信区间，每30分钟延迟1.01-1.22）是血管重建成功后功能依赖的预测因素。症状发作至再灌注时间超过5小时与功能依赖相关。所有有症状性颅内出血的受试者均存在功能依赖。半数成功的机械取栓患者预后不佳。年龄、严重的神经功能缺损和延迟的血管内治疗与功能依赖相关，尽管血管重建术成功。我们的数据支持尽量减少急性缺血性卒中患者血管内治疗的延迟，以改善预后。
High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy. We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization. Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02–1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01–1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence. One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.