Abstract：
OBJECTIVE: The outcomes of patients with large ischemic core who fail to recanalize with endovascular therapy (EVT) compared to medical management (MM) are uncertain. The objective was to evaluate the clinical and safety outcomes of patients who underwent EVT in patients with large ischemic core and unsuccessful recanalization.
METHODS: This was a post hoc analysis of the ANGEL-ASPECT randomized trial. Unsuccessful recanalization was defined as patients who underwent EVT with eTICI 0-2a. The primary endpoint was 90-day very poor outcome (mRS 5-6). Multivariable logistic regression was conducted controlling for ASPECTS, occlusion location, intravenous thrombolysis, and time to treatment.
RESULTS: Of 455 patients 225 were treated with MM. Of 230 treated with EVT, 43 (19%) patients had unsuccessful recanalization. There was no difference in 90-day very poor outcomes (39.5% vs. 40%, aOR 0.93, 95% confidence interval, CI 0.47-1.85, p = 0.95), sICH (7.0% vs. 2.7%, aOR 2.81, 95% CI 0.6-13.29, p = 0.19), or mortality (30% vs. 20%, aOR 1.65, 95% CI 0.89-3.06, p = 0.11) between the unsuccessful EVT and MM groups, respectively. There were higher rates of ICH (55.8% vs. 17.3%, p < 0.001), infarct core volume growth (142.7 ml vs. 90.5 ml, β = 47.77, 95% CI 20.97-74.57 ml, p < 0.001), and decompressive craniectomy (18.6% vs. 3.6%, p < 0.001) in the unsuccessful EVT versus MM groups.
CONCLUSIONS: In a randomized trial of patients with large ischemic core undergoing EVT with unsuccessful recanalization, there was no difference in very poor outcomes, sICH or death versus medically managed patients. In the unsuccessful EVT group, there were higher rates of any ICH, volume of infarct core growth, and decompressive craniectomy.
METHODS: This was a post hoc analysis of the ANGEL-ASPECT randomized trial. Unsuccessful recanalization was defined as patients who underwent EVT with eTICI 0-2a. The primary endpoint was 90-day very poor outcome (mRS 5-6). Multivariable logistic regression was conducted controlling for ASPECTS, occlusion location, intravenous thrombolysis, and time to treatment.
RESULTS: Of 455 patients 225 were treated with MM. Of 230 treated with EVT, 43 (19%) patients had unsuccessful recanalization. There was no difference in 90-day very poor outcomes (39.5% vs. 40%, aOR 0.93, 95% confidence interval, CI 0.47-1.85, p = 0.95), sICH (7.0% vs. 2.7%, aOR 2.81, 95% CI 0.6-13.29, p = 0.19), or mortality (30% vs. 20%, aOR 1.65, 95% CI 0.89-3.06, p = 0.11) between the unsuccessful EVT and MM groups, respectively. There were higher rates of ICH (55.8% vs. 17.3%, p < 0.001), infarct core volume growth (142.7 ml vs. 90.5 ml, β = 47.77, 95% CI 20.97-74.57 ml, p < 0.001), and decompressive craniectomy (18.6% vs. 3.6%, p < 0.001) in the unsuccessful EVT versus MM groups.
CONCLUSIONS: In a randomized trial of patients with large ischemic core undergoing EVT with unsuccessful recanalization, there was no difference in very poor outcomes, sICH or death versus medically managed patients. In the unsuccessful EVT group, there were higher rates of any ICH, volume of infarct core growth, and decompressive craniectomy.
摘要：
目的：与药物治疗（MM）相比，血管内治疗（EVT）失败的大缺血核心患者的预后尚不确定。目的是评估大缺血核心和未成功再通的患者接受EVT的临床和安全性结果。
方法：这是对ANGEL-ASPECT随机试验的事后分析。未成功再通定义为接受eTICI0-2aEVT的患者。主要终点是90天非常差的结果（mRS5-6）。多变量logistic回归进行控制，遮挡位置,静脉溶栓,和治疗时间。
结果：455例患者中，225例接受了MM治疗。230例接受EVT治疗，43例（19%）患者再通失败。90天非常差的结果没有差异（39.5%与40%,OR0.93,95%置信区间,CI0.47-1.85，p=0.95），sICH（7.0%与2.7%,OR2.81，95%CI0.6-13.29，p=0.19)，或死亡率(30%vs.20%,OR1.65，95%CI0.89-3.06，p=0.11)在不成功的EVT和MM组之间，分别。ICH的发生率更高(55.8%vs.17.3%,p<0.001)，梗死核心体积增长（142.7mlvs.90.5ml,β=47.77，95%CI20.97-74.57ml，p<0.001)，和去骨瓣减压术(18.6%vs.3.6%,p<0.001）在不成功的EVT与MM组中。
结论：在接受EVT但未成功再通的大缺血核心患者的随机试验中，非常差的结果没有差异，sICH或死亡与医学管理的患者。在不成功的EVT组中，任何ICH的比率都更高，梗死核心生长量，去骨瓣减压术.
方法：这是对ANGEL-ASPECT随机试验的事后分析。未成功再通定义为接受eTICI0-2aEVT的患者。主要终点是90天非常差的结果（mRS5-6）。多变量logistic回归进行控制，遮挡位置,静脉溶栓,和治疗时间。
结果：455例患者中，225例接受了MM治疗。230例接受EVT治疗，43例（19%）患者再通失败。90天非常差的结果没有差异（39.5%与40%,OR0.93,95%置信区间,CI0.47-1.85，p=0.95），sICH（7.0%与2.7%,OR2.81，95%CI0.6-13.29，p=0.19)，或死亡率(30%vs.20%,OR1.65，95%CI0.89-3.06，p=0.11)在不成功的EVT和MM组之间，分别。ICH的发生率更高(55.8%vs.17.3%,p<0.001)，梗死核心体积增长（142.7mlvs.90.5ml,β=47.77，95%CI20.97-74.57ml，p<0.001)，和去骨瓣减压术(18.6%vs.3.6%,p<0.001）在不成功的EVT与MM组中。
结论：在接受EVT但未成功再通的大缺血核心患者的随机试验中，非常差的结果没有差异，sICH或死亡与医学管理的患者。在不成功的EVT组中，任何ICH的比率都更高，梗死核心生长量，去骨瓣减压术.
