Abstract：
UNASSIGNED: Acute ischemic stroke (AIS) from primary medium vessel occlusions (MeVO) is a prevalent condition associated with substantial morbidity and mortality. Despite the common use of mechanical thrombectomy (MT) in AIS, predictors of poor outcomes in MeVO remain poorly characterized.
UNASSIGNED: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021.
UNASSIGNED: Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5-6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76.
UNASSIGNED: This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.
UNASSIGNED: In this prospectively collected, retrospectively reviewed, multicenter, multinational study, data from the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry were analyzed. The study included 1568 patients from 37 academic centers across North America, Asia, and Europe, treated with MT, with or without intravenous tissue plasminogen activator (IVtPA), between September 2017 and July 2021.
UNASSIGNED: Among the 1568 patients, 347 (22.2%) experienced very poor outcomes (modified Rankin score (mRS), 5-6). Key predictors of poor outcomes were advanced age (odds ratio (OR): 1.03; 95% confidence interval (CI): 1.02 to 1.04; p < 0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR: 1.07; 95% CI: 1.05 to 1.10; p < 0.001), pre-operative glucose levels (OR: 1.01; 95% CI: 1.00 to 1.02; p < 0.001), and a baseline mRS of 4 (OR: 2.69; 95% CI: 1.25 to 5.82; p = 0.011). The multivariable model demonstrated good predictive accuracy with an area under the receiver-operating characteristic (ROC) curve of 0.76.
UNASSIGNED: This study demonstrates that advanced age, higher NIHSS scores, elevated pre-stroke mRS, and pre-operative glucose levels significantly predict very poor outcomes in AIS-MeVO patients who received MT. These findings highlight the importance of a comprehensive risk assessment in primary MeVO patients for personalized treatment strategies. However, they also suggest a need for cautious patient selection for endovascular thrombectomy. Further prospective studies are needed to confirm these findings and explore targeted therapeutic interventions.
摘要：
背景：原发性中等血管闭塞（MeVO）引起的急性缺血性卒中（AIS）是一种与大量发病率和死亡率相关的普遍状况。尽管在AIS中普遍使用机械血栓切除术（MT），MeVO不良结局的预测因子仍然缺乏表征。
方法：在这一前瞻性收集中，回顾性审查，多中心，跨国研究，分析了MAD-MT注册的数据.该研究包括来自北美37个学术中心的1,568名患者。亚洲,和欧洲,机械血栓切除术（MT），有或没有静脉注射组织纤溶酶原激活剂（IVtPA），2017年9月至2021年7月。
结果：在1,568名患者中，347（22.2%）的结果非常差（mRS5-6）。不良结局的关键预测因素是高龄（OR：1.03;95％CI：1.02至1.04;p<0.001），较高的基线NIHSS评分（OR：1.07；95％CI：1.05至1.10；p<0.001），术前血糖水平（OR：1.01;95％CI：1.00至1.02;p<0.001），基线mRS为4（OR：2.69；95%CI：1.25至5.82；p=0.011）。多变量模型显示出良好的预测准确性，接收器工作特征（ROC）曲线下的面积为0.76。
结论：这项研究表明，高龄，更高的NIHSS分数，中风前MRS升高，术前血糖水平可显着预测接受MT的AIS-MeVO患者的不良结局。这些发现强调了在原发性MeVO患者中进行全面风险评估对于个性化治疗策略的重要性。然而,他们还建议需要谨慎选择血管内血栓切除术的患者.需要进一步的前瞻性研究来证实这些发现并探索有针对性的治疗干预措施。
方法：在这一前瞻性收集中，回顾性审查，多中心，跨国研究，分析了MAD-MT注册的数据.该研究包括来自北美37个学术中心的1,568名患者。亚洲,和欧洲,机械血栓切除术（MT），有或没有静脉注射组织纤溶酶原激活剂（IVtPA），2017年9月至2021年7月。
结果：在1,568名患者中，347（22.2%）的结果非常差（mRS5-6）。不良结局的关键预测因素是高龄（OR：1.03;95％CI：1.02至1.04;p<0.001），较高的基线NIHSS评分（OR：1.07；95％CI：1.05至1.10；p<0.001），术前血糖水平（OR：1.01;95％CI：1.00至1.02;p<0.001），基线mRS为4（OR：2.69；95%CI：1.25至5.82；p=0.011）。多变量模型显示出良好的预测准确性，接收器工作特征（ROC）曲线下的面积为0.76。
结论：这项研究表明，高龄，更高的NIHSS分数，中风前MRS升高，术前血糖水平可显着预测接受MT的AIS-MeVO患者的不良结局。这些发现强调了在原发性MeVO患者中进行全面风险评估对于个性化治疗策略的重要性。然而,他们还建议需要谨慎选择血管内血栓切除术的患者.需要进一步的前瞻性研究来证实这些发现并探索有针对性的治疗干预措施。
