Abstract：
BACKGROUND: Endovascular treatment (EVT) is the standard of care of ischaemic stroke due to occlusion of large vessels. Although EVT can significantly improve short- and long-term outcomes, functional dependence can persist despite the achievement of a successful recanalization. The evidence about the predictors of post-stroke epilepsy (PSE) in patients with stroke treated by EVT is limited. We aimed to evaluate the relationship between futile recanalization and the risk of PSE.
METHODS: We retrospectively identified consecutive adults with first-ever ischaemic stroke of anterior circulation who were treated with EVT. Futile recanalization was defined as poor 3-month functional status (modified Rankin scale score ≥ 3) despite complete or near-complete recanalization. Study outcome was the occurrence of PSE during the follow-up.
RESULTS: The study included 327 patients with anterior circulation ischaemic stroke treated with EVT. Futile recanalization occurred in 116 (35.5%) patients and 26 (8.0%) developed PSE during a median follow-up of 35 [interquartile range, 22.7-55.2] months. Futile recanalization was more common among patients who developed PSE compared to those who did not (76.9% versus 31.9%; p < 0.001). Futile recanalization [hazard ratio (HR) = 5.63, 95% confidence interval (CI): 1.88-16.84; p = 0.002], large artery atherosclerosis (HR = 3.48, 95% CI: 1.44-8.40; p = 0.006), cortical involvement (HR = 15.51, 95% CI: 2.06-116.98; p = 0.008), and acute symptomatic status epilepticus (HR = 14.40, 95% CI: 2.80-73.98; p = 0.001) increased the risk of PSE.
CONCLUSIONS: Futile recanalization after EVT is associated with increased risk of PSE in patients with ischaemic stroke due to occlusion of large vessel of the anterior circulation.
METHODS: We retrospectively identified consecutive adults with first-ever ischaemic stroke of anterior circulation who were treated with EVT. Futile recanalization was defined as poor 3-month functional status (modified Rankin scale score ≥ 3) despite complete or near-complete recanalization. Study outcome was the occurrence of PSE during the follow-up.
RESULTS: The study included 327 patients with anterior circulation ischaemic stroke treated with EVT. Futile recanalization occurred in 116 (35.5%) patients and 26 (8.0%) developed PSE during a median follow-up of 35 [interquartile range, 22.7-55.2] months. Futile recanalization was more common among patients who developed PSE compared to those who did not (76.9% versus 31.9%; p < 0.001). Futile recanalization [hazard ratio (HR) = 5.63, 95% confidence interval (CI): 1.88-16.84; p = 0.002], large artery atherosclerosis (HR = 3.48, 95% CI: 1.44-8.40; p = 0.006), cortical involvement (HR = 15.51, 95% CI: 2.06-116.98; p = 0.008), and acute symptomatic status epilepticus (HR = 14.40, 95% CI: 2.80-73.98; p = 0.001) increased the risk of PSE.
CONCLUSIONS: Futile recanalization after EVT is associated with increased risk of PSE in patients with ischaemic stroke due to occlusion of large vessel of the anterior circulation.
摘要：
背景：血管内治疗（EVT）是由于大血管闭塞引起的缺血性卒中的标准治疗方法。虽然EVT可以显著改善短期和长期结果，尽管实现了成功的再通，但功能依赖仍然可以持续。关于EVT治疗的卒中后癫痫（PSE）患者的预测因素的证据有限。我们旨在评估无效再通与PSE风险之间的关系。
方法：我们回顾性地确定了接受EVT治疗的连续成人首次发生前循环缺血性卒中。Futille再通定义为尽管完全或接近完全再通，但3个月功能状态差（改良Rankin量表评分≥3）。研究结果为随访期间PSE的发生。
结果：本研究包括327例接受EVT治疗的前循环缺血性卒中患者。在中位随访35[四分位数范围内，116例（35.5％）患者发生了虚假再通，26例（8.0％）发生了PSE，22.7-55.2]个月。与未发生PSE的患者相比，发生PSE的患者更常见（76.9％对31.9％；p<0.001）。徒劳的再通[风险比（HR）=5.63，95％置信区间（CI）：1.88-16.84；p=0.002]，大动脉粥样硬化(HR=3.48,95%CI:1.44-8.40;p=0.006),皮质受累（HR=15.51，95%CI：2.06-116.98；p=0.008），和急性症状性癫痫持续状态（HR=14.40，95％CI：2.80-73.98；p=0.001）增加PSE的风险。
结论：在前循环大血管闭塞引起的缺血性卒中患者，EVT后Futtile再通与PSE风险增加相关。
方法：我们回顾性地确定了接受EVT治疗的连续成人首次发生前循环缺血性卒中。Futille再通定义为尽管完全或接近完全再通，但3个月功能状态差（改良Rankin量表评分≥3）。研究结果为随访期间PSE的发生。
结果：本研究包括327例接受EVT治疗的前循环缺血性卒中患者。在中位随访35[四分位数范围内，116例（35.5％）患者发生了虚假再通，26例（8.0％）发生了PSE，22.7-55.2]个月。与未发生PSE的患者相比，发生PSE的患者更常见（76.9％对31.9％；p<0.001）。徒劳的再通[风险比（HR）=5.63，95％置信区间（CI）：1.88-16.84；p=0.002]，大动脉粥样硬化(HR=3.48,95%CI:1.44-8.40;p=0.006),皮质受累（HR=15.51，95%CI：2.06-116.98；p=0.008），和急性症状性癫痫持续状态（HR=14.40，95％CI：2.80-73.98；p=0.001）增加PSE的风险。
结论：在前循环大血管闭塞引起的缺血性卒中患者，EVT后Futtile再通与PSE风险增加相关。
