Abstract：
UNASSIGNED: Endovascular treatment (EVT) is part of the usual care for proximal vessel occlusion strokes. However, the safety and effectiveness of EVT for distal medium vessel occlusions remain unclear. We sought to compare the clinical outcomes of EVT to medical management (MM) for isolated distal medium vessel occlusions.
UNASSIGNED: This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0-2) and excellent (mRS score, 0-1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.
UNASSIGNED: A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95-1.64]; P=0.110), rates of good (mRS score, 0-2; aOR, 1.32 [95% CI, 0.97-1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94-1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78-1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21-1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24-0.85]; P=0.013) in the EVT group.
UNASSIGNED: This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.
UNASSIGNED: This is a retrospective analysis of prospectively collected data from seven comprehensive stroke centers. Patients were included if they had isolated distal medium vessel occlusion strokes due to middle cerebral artery M3/M4, anterior cerebral artery A2/A3, or posterior cerebral artery P1/P2 segments. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included 90-day good (mRS score, 0-2) and excellent (mRS score, 0-1) outcomes. Safety measures included symptomatic intracranial hemorrhage and 90-day mortality.
UNASSIGNED: A total of 321 patients were included in the analysis (EVT, 179; MM, 142; 40.8% treated with intravenous thrombolysis). In the inverse probability of treatment weighting model, there were no significant differences between EVT and MM in terms of the overall degree of disability (mRS ordinal shift; adjusted odds ratio [aOR], 1.25 [95% CI, 0.95-1.64]; P=0.110), rates of good (mRS score, 0-2; aOR, 1.32 [95% CI, 0.97-1.80]; P=0.075) and excellent (aOR, 1.32 [95% CI, 0.94-1.85]; P=0.098) outcomes, or mortality (aOR, 1.20 [95% CI, 0.78-1.85]; P=0.395) at 90 days. The multivariable regression model showed similar findings. Moreover, there was no difference between EVT and MM in rates of symptomatic intracranial hemorrhage in the multivariable regression model (aOR, 0.57 [95% CI, 0.21-1.58]; P=0.277), but the inverse probability of treatment weighting model showed a lower likelihood of symptomatic intracranial hemorrhage (aOR, 0.46 [95% CI, 0.24-0.85]; P=0.013) in the EVT group.
UNASSIGNED: This multicenter study failed to demonstrate any significant outcome differences among patients with isolated distal medium vessel occlusions treated with EVT versus MM. These findings reinforce clinical equipoise. Randomized clinical trials are ongoing and will provide more definite evidence.
摘要：
■血管内治疗（EVT）是近端血管闭塞中风的常规护理的一部分。然而,EVT治疗远端中等血管闭塞的安全性和有效性尚不清楚.我们试图比较EVT与医疗管理（MM）对孤立的远端中等血管闭塞的临床结果。
■这是对七个综合卒中中心前瞻性收集的数据的回顾性分析。如果患者由于大脑中动脉M3/M4，大脑前动脉A2/A3或大脑后动脉P1/P2段而发生孤立的远端中等血管闭塞中风，则将其包括在内。用多变量逻辑回归和治疗加权的逆概率比较接受EVT或MM治疗的患者。主要结果是90天时通过改良的Rankin量表（mRS）测量的残疾程度的变化。次要结果包括90天良好（mRS评分，0-2）和优秀（mRS评分，0-1）结果。安全性措施包括症状性颅内出血和90天死亡率。
■总共321名患者被纳入分析(EVT，179;MM,142；40.8%接受静脉溶栓治疗）。在治疗加权逆概率模型中，EVT和MM在总体残疾程度方面没有显着差异(mRS序数移位；调整比值比[aOR]，1.25[95%CI，0.95-1.64]；P=0.110），良好率(MRS评分，0-2；aOR，1.32[95%CI，0.97-1.80]；P=0.075)和优秀(aOR，1.32[95%CI，0.94-1.85]；P=0.098）结果，或死亡率(AOR，90天时1.20[95%CI，0.78-1.85]；P=0.395）。多元回归模型显示了相似的结果。此外，在多变量回归模型中，EVT和MM的症状性颅内出血发生率没有差异(aOR，0.57[95%CI，0.21-1.58]；P=0.277)，但治疗加权模型的逆概率显示症状性颅内出血的可能性较低(aOR，EVT组0.46[95%CI，0.24-0.85]；P=0.013）。
■这项多中心研究未能证明接受EVT和MMT治疗的孤立性远端中等血管闭塞患者的任何显著结果差异。这些发现加强了临床平衡。随机临床试验正在进行中，并将提供更明确的证据。
■这是对七个综合卒中中心前瞻性收集的数据的回顾性分析。如果患者由于大脑中动脉M3/M4，大脑前动脉A2/A3或大脑后动脉P1/P2段而发生孤立的远端中等血管闭塞中风，则将其包括在内。用多变量逻辑回归和治疗加权的逆概率比较接受EVT或MM治疗的患者。主要结果是90天时通过改良的Rankin量表（mRS）测量的残疾程度的变化。次要结果包括90天良好（mRS评分，0-2）和优秀（mRS评分，0-1）结果。安全性措施包括症状性颅内出血和90天死亡率。
■总共321名患者被纳入分析(EVT，179;MM,142；40.8%接受静脉溶栓治疗）。在治疗加权逆概率模型中，EVT和MM在总体残疾程度方面没有显着差异(mRS序数移位；调整比值比[aOR]，1.25[95%CI，0.95-1.64]；P=0.110），良好率(MRS评分，0-2；aOR，1.32[95%CI，0.97-1.80]；P=0.075)和优秀(aOR，1.32[95%CI，0.94-1.85]；P=0.098）结果，或死亡率(AOR，90天时1.20[95%CI，0.78-1.85]；P=0.395）。多元回归模型显示了相似的结果。此外，在多变量回归模型中，EVT和MM的症状性颅内出血发生率没有差异(aOR，0.57[95%CI，0.21-1.58]；P=0.277)，但治疗加权模型的逆概率显示症状性颅内出血的可能性较低(aOR，EVT组0.46[95%CI，0.24-0.85]；P=0.013）。
■这项多中心研究未能证明接受EVT和MMT治疗的孤立性远端中等血管闭塞患者的任何显著结果差异。这些发现加强了临床平衡。随机临床试验正在进行中，并将提供更明确的证据。
