■目前的证据为M2段大脑中动脉闭塞患者的血管内血栓切除术(EVT)的优越性提供了有限的支持。我们旨在研究M2段闭塞的影像学特征是否会影响EVT的有效性。
■我们从2017年1月至2022年1月进行了一项回顾性队列研究,数据来自CASEII注册(基于计算机的急性卒中患者在线数据库,用于卒中管理质量评估),这特别记录了急性缺血性卒中患者出现M2段闭塞,正在接受再灌注治疗。将患者分为静脉溶栓(IVT)组(单独IVT)和EVT组(IVT加EVT或单独EVT)。主要结果是90天时修改的Rankin量表评分0至2。次要结果包括附加阈值和改良Rankin量表评分的分布,24小时再通,早期神经退化,住院期间的相关并发症。安全性结果包括24小时颅内出血事件和90天死亡。使用具有倾向评分匹配的二元逻辑回归分析。根据闭塞的解剖部位进行亚组分析,包括右与左,近端与远端,显性/共显性与非显性,单分支与双/三分支(ES),和前支与中央/后支。
■在734例患者中(43.3%为女性;中位年龄,73年),M2段闭塞,EVT组342例(46.6%)。倾向得分匹配分析显示主要结局没有统计学差异(比值比,EVT组和IVT组之间为0.860[95%CI,0.611-1.209];P=0.385)。然而,EVT与蛛网膜下腔出血的发生率较高相关(比值比,6.655[95%CI,1.487-29.788];P=0.004)和肺炎(赔率比,2.015[95%CI,1.364-2.977];P<0.001)。亚组分析表明,IVT组的患者在正确的情况下取得了更好的结果,远端,或非显性分支闭塞(Pall相互作用<0.05)。
■我们的研究表明,在急性M2段大脑中动脉闭塞中,EVT与单独IVT的效率相似。这表明,只有特定的患者亚群可能比单独的IVT具有潜在的更高的EVT益处。
■URL:https://clinicaltrials.gov;唯一标识符:NCT04487340。
UNASSIGNED: Current evidence provides limited support for the superiority of endovascular thrombectomy (EVT) in patients with M2 segment middle cerebral artery occlusion. We aim to investigate whether imaging features of M2 segment occlusion impact the effectiveness of EVT.
UNASSIGNED: We conducted a retrospective cohort study from January 2017 to January 2022, drawing data from the CASE II registry (Computer-Based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation), which specifically documented patients with acute ischemic stroke presenting with M2 segment occlusion undergoing reperfusion therapy. Patients were stratified into the intravenous thrombolysis (IVT) group (IVT alone) and EVT group (IVT plus EVT or EVT alone). The primary outcome was a modified Rankin Scale score 0 to 2 at 90 days. Secondary outcomes included additional thresholds and distribution of modified Rankin Scale scores, 24-hour recanalization, early neurological deterioration, and relevant complications during hospitalization. Safety outcomes encompassed intracranial hemorrhagic events at 24 hours and mortality at 90 days. Binary logistic regression analyses with propensity score matching were used. Subgroup analyses were performed based on the anatomic site of occlusion, including right versus left, proximal versus distal, dominant/co-dominant versus nondominant, single versus double/triple branch(es), and anterior versus central/posterior branch.
UNASSIGNED: Among 734 patients (43.3% were females; median age, 73 years) with M2 segment occlusion, 342 (46.6%) were in the EVT group. Propensity score matching analysis revealed no statistical difference in the primary outcome (odds ratio, 0.860 [95% CI, 0.611-1.209]; P=0.385) between the EVT group and IVT group. However, EVT was associated with a higher incidence of subarachnoid hemorrhage (odds ratio, 6.655 [95% CI, 1.487-29.788]; P=0.004) and pneumonia (odds ratio, 2.015 [95% CI, 1.364-2.977]; P<0.001). Subgroup analyses indicated that patients in the IVT group achieved better outcomes when presenting with right, distal, or nondominant branch occlusion (Pall interaction<0.05).
UNASSIGNED: Our study showed similar efficiency of EVT versus IVT alone in acute M2 segment middle cerebral artery occlusion. This suggested that only specific patient subpopulations might have a potentially higher benefit of EVT over IVT alone.
UNASSIGNED: URL: https://clinicaltrials.gov; Unique identifier: NCT04487340.