Ischemic Strokes Due to Large-Vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death: A Review.
Ischemic Strokes Due to Large-Vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death: A Review.
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DOI：
10.3389/fneur.2017.00651
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发表时间：
2017
影响因子：
3.4
通讯作者：
Saver JL
中科院分区：
文献类型：
--
作者：
Malhotra K;Gornbein J;Saver JL
由于大血管闭塞（LVO）相关的急性缺血性卒中（AIS）与更严重的功能障碍相关，我们假设血管内血栓切除术（ET）可能不成比例地有利于卒中相关的依赖性和死亡。为了描述LVO-AIS的影响，系统检索确定了测量症状发作24小时内同时出现LVO和非LVO事件的连续患者中缺血性卒中后的依赖性或死亡[改良兰金量表（mRS）3-6]或死亡率的研究。在审查的197篇文章中，2篇符合纳入标准，共招募了1，467例患者。LVO后3-6个月内的依赖性或死亡率（mRS 3-6）高于非LVO缺血性卒中，分别为64%和24%，比值比（OR）4.46（CI：3.53-5.63，p < 0.0001）。LVO后3-6个月内的死亡率高于非LVO缺血性中风，分别为26.2%和1.3%，OR 4.09（CI：2.5-6.68），p < 0.0001。因此，虽然LVO缺血性事件占所有急性缺血性卒中的38.7%（CI：21.8-55.7%），但它们占卒中后依赖或死亡的61.6%（CI：41.8-81.3%）和卒中后死亡的95.6%（CI：89.0-98.8%）。使用基于文献的预测LVO脑缺血患者在发病8小时内可治疗，ET可用于21.4%的急性缺血性卒中患者，这些事件占卒中后依赖和死亡的34%和卒中后死亡的52.8%。LVO引起急性AIS的三分之一多一点，但对AIS后五分之三的依赖性和十分之九以上的死亡率负责。在人群水平上，ET在减少严重卒中结局方面具有不成比例的获益。
Since large-vessel occlusion (LVO)-related acute ischemic strokes (AIS) are associated with more severe deficits, we hypothesize that the endovascular thrombectomy (ET) may disproportionately benefit stroke-related dependence and death. To delineate LVO-AIS impact, systematic search identified studies measuring dependence or death [modified Rankin Scale (mRS) 3–6] or mortality following ischemic stroke among consecutive patients presenting with both LVO and non-LVO events within 24 h of symptom onset. Among 197 articles reviewed, 2 met inclusion criteria, collectively enrolling 1,467 patients. Rates of dependence or death (mRS 3–6) within 3–6 months were higher after LVO than non-LVO ischemic stroke, 64 vs. 24%, odds ratio (OR) 4.46 (CI: 3.53–5.63, p < 0.0001). Mortality within 3–6 months was higher after LVO than non-LVO ischemic stroke, 26.2 vs. 1.3%, OR 4.09 (CI: 2.5–6.68), p < 0.0001. Consequently, while LVO ischemic events accounted for 38.7% (CI: 21.8–55.7%) of all acutely presenting ischemic strokes, they accounted for 61.6% (CI: 41.8–81.3%) of poststroke dependence or death and 95.6% (CI: 89.0–98.8%) of poststroke mortality. Using literature-based projections of LVO cerebral ischemia patients treatable within 8 h of onset, ET can be used in 21.4% of acutely presenting patients with ischemic stroke, and these events account for 34% of poststroke dependence and death and 52.8% of poststroke mortality. LVOs cause a little more than one-third of acutely presenting AIS, but are responsible for three-fifths of dependency and more than nine-tenths of mortality after AIS. At the population level, ET has a disproportionate benefit in reducing severe stroke outcomes.
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