Clinical Outcome After Mechanical Thrombectomy in Patients with Diabetes with Major Ischemic Stroke of the Anterior Circulation
Clinical Outcome After Mechanical Thrombectomy in Patients with Diabetes with Major Ischemic Stroke of the Anterior Circulation
复制标题
DOI：
10.1016/j.wneu.2018.08.032
复制
发表时间：
2018-12-01
影响因子：
2
通讯作者：
Mpotsaris, Anastasios
中科院分区：
文献类型：
--
作者：
Borggrefe, Jan;Glueck, Berit;Mpotsaris, Anastasios
背景：在接受机械血栓切除术（MT）治疗的急性缺血性卒中患者中，与非糖尿病患者（NDP）相比，糖尿病患者（DP）的预后较差。本研究旨在对前循环卒中接受 MT 的 DP 不良结局相关因素进行综合分析。 方法：本研究纳入了 498 例连续接受颈内动脉终末和/或大脑中动脉急性缺血性卒中介入治疗的患者中的 317 例，其中 46 例 DP。研究数据包括治疗前和治疗后的中风计算机断层扫描，包括灌注数据、侧支状况、治疗数据，包括治疗时间、预先存在的心血管危险因素、脑血管事件、合并症、实验室参数和药物治疗。在基线时（美国国立卫生研究院卒中量表 [NIHSS]/改良 Rankin 量表 [mRS]）和 90 天后 (mRS 90) 评估神经系统状态。 结果：与 NDP 相比，DP 的预后明显较差 (mRS90 >2) (P < 0.05)。各组之间的侧支循环和梗死核心大小没有差异，而 DP 中的半影明显小于 NDP 中（P < 0.05）。 DP 中较差的 mRS90 结果 (mRS90 > 2) 与循环不良 (P = 0.01) 和入院时高血糖 (P < 0.05) 相关。 NDP 组中较短的再灌注时间与有利的 mRS90 相关（P < 0.001），但与 DP 组（P = 0.49）无关。在单变量逻辑回归中，以下参数与 mRS90 显着相关：糖尿病、入院时高血糖、再灌注时间和 NIHSS 评分（均 P < 0.05）。在所有变量的多变量分析和分区回归模型中，入院高血糖（>= 132 mg/dl）和年龄较大（>= 66岁）的DP表现出特别差的结果。结论：MT后DP不良结果的主要因素是入院高血糖、年龄和NIHSS评分。
BACKGROUND: Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation.METHODS: This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/ modified Rankin Scale [mRS]) and after 90 days (mRS 90).RESULTS: Compared with NDP, DP showed a significantly poorer outcome (mRS90 >2) (P < 0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P < 0.05). The poorer mRS90 outcome (mRS90 > 2) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P < 0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P < 0.001) but not the DP (P = 0.49) group. In uni-variate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P < 0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (>= 132 mg/dl) and older age (>= 66 years) showed a particularly poor outcome.CONCLUSIONS: The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score.