Characteristics and prognostic impact of unsuccessful recanalization after endovascular therapy for acute ischemic stroke

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Neurological Sciences Pub Date : 2024-09-18 DOI:10.1016/j.jns.2024.123247

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引用次数: 0

Abstract

Background

Endovascular therapy (EVT) has shown high therapeutic efficacy for acute large vessel occlusion (LVO); however, recanalization is unsuccessful in some cases. This study aimed to examine the characteristics and prognostic impact of unsuccessful recanalization after EVT compared with medical treatment alone.

Methods

We conducted a post hoc analysis of RESCUE-Japan Registry 2, a nationwide registry of 2408 consecutive patients with acute LVO. Patients without successful recanalization after EVT (thrombolysis in cerebral infarction grade ≤ 2a) were classified into the Unsuccessful EVT group, and compared with the No-EVT group. To account for selection bias, the outcomes were compared in a propensity score-matched cohort. The outcomes included the modified Rankin Scale (mRS) score at 90 days and intracranial hemorrhage within 72 h after the LVO onset.

Results

Among 188 (14.7 %) patients in the Unsuccessful EVT group out of 1281 who underwent EVT, 147 were matched with the No-EVT group, with comparable baseline characteristics. Patients in the Unsuccessful EVT group had a higher distribution of mRS score at 90 days and were less likely to achieve mRS 0–2 compared to those in the No-EVT group (23 % vs. 34 %, OR:0.58, 95 % CI:0.35–0.98). All-cause mortality was higher in the Unsuccessful EVT group (16 % vs. 6.8 %, OR: 2.54, 95 % CIs: 1.16–5.55). Symptomatic intracranial hemorrhage was more frequently observed in the Unsuccessful EVT group (5.4 % vs. 0.7 %, OR: 8.40, 95 % CIs: 1.04–68.1).

Conclusions

The clinical outcomes of patients without successful recanalization after EVT were worse than those who did not undergo EVT.

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急性缺血性脑卒中血管内治疗后未成功再通畅的特征和对预后的影响

背景血管内治疗（EVT）对急性大血管闭塞（LVO）具有很高的疗效，但在某些病例中，血管再通术并不成功。本研究旨在研究与单纯药物治疗相比，EVT 后未成功再通的患者的特征及其对预后的影响。方法我们对 RESCUE-Japan Registry 2 进行了一项事后分析，这是一项全国性的登记，连续登记了 2408 名急性 LVO 患者。EVT后未成功再通（脑梗塞溶栓治疗分级≤2a）的患者被归入EVT不成功组，并与No-EVT组进行比较。为考虑选择偏差，在倾向评分匹配队列中对结果进行了比较。结果在接受EVT的1281名患者中，未成功EVT组有188名（14.7%）患者，其中147名与未成功EVT组匹配，基线特征相当。与未接受EVT组相比，未成功接受EVT组患者在90天时的mRS评分分布较高，达到mRS 0-2的可能性较低（23% vs. 34%，OR:0.58，95% CI:0.35-0.98）。EVT不成功组的全因死亡率更高（16% vs. 6.8%，OR：2.54，95 % CIs：1.16-5.55）。结论 EVT后未成功再通的患者的临床预后比未接受EVT的患者更差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Neurological Sciences 医学-临床神经学

CiteScore

7.60

自引率

2.30%

发文量

313

审稿时长

22 days

期刊介绍： The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.