The number of recanalization attempts, procedure time and endovascular therapy outcomes in acute large core stroke patients

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology Pub Date : 2025-01-09 DOI:10.1016/j.neurad.2024.101241

Yapeng Guo , Changwei Guo , Dahong Yang , Shitao Fan , Xu Xu , Jinfu Ma , Zibao Li , Shihai Yang , Xiaolei Shi , Zhixi Wang , Wenjie Zi , Guoyong Zeng , Xianjun Huang

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引用次数: 0

Abstract

Introduction

Landmark thrombectomy trials demonstrated improved functional outcomes after endovascular therapy (EVT) for large core strokes (LCSs). This study explored the impact of recanalization attempts and procedure time (PT) on outcomes in LCS patients.

Patients and Methods

This was a retrospective study of patients with LCSs who underwent EVT from a prospective multicentre cohort. LCS was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were divided into 6 groups (unsuccessful reperfusion [modified Thrombolysis in Cerebral Infarction Scale (mTICI) 0–2a] and successful reperfusion [mTICI, 2b/3]) after 1, 2, 3, 4, or >4 attempts. The primary outcome was a favorable 90-day mRS score of 0–3. Secondary outcomes included mRS 0–4, 90-day mortality, and 48-hour rates of symptomatic (sICH) and any intracranial hemorrhage (aICH).

Results

A total of 447 patients were analysed. 388 with successful reperfusion, 59 without.Successful reperfusion during the first 3 passes increased the odds of favourable functional outcomes [attempt 1: aOR, 4.454 (1.723–11.514),p=0.002; 2: aOR, 3.762 (1.437–9.847),p=0.07; or 3: aOR, 3.619 (1.254–10.440),p=0.017] and decreased mortality at 90 days [(attempt 1: aOR, 0.336 (0.155–0.727),p=0.006; 2: aOR, 0.346 (0.160–0.746),p=0.007; or 3: aOR, 0.395 (0.164–0.953),p=0.039]. A shorter PT increased the odds of a favourable functional outcome [aOR, 0.991 (0.985–0.997),p=0.002]. PT may reduce the association between the number of attempts and patient outcomes. No associations were found between the number of attempts and sICH or aICH, whereas there was an increasing trend in the proportion of aICH or sICH when the number of attempts was more than two.

Conclusion

In patients with LCSs who underwent EVT, successful reperfusion within the first 3 attempts and a shorter PT were associated with favourable functional outcomes. However, the effect size of the association between the number of attempts and clinical outcomes may gradually decrease with extension of the PT.

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急性大核心脑卒中患者再通尝试次数、手术时间和血管内治疗结果。

具有里程碑意义的取栓试验表明，在血管内治疗（EVT）后，大核心卒中（LCSs）的功能预后得到改善。本研究探讨再通尝试次数和手术时间（PT）对LCS患者预后的影响。患者和方法：这是一项来自前瞻性多中心队列的lcs接受EVT患者的回顾性研究。LCS被定义为阿尔伯塔中风项目早期计算机断层扫描评分0到5分。将患者分为1、2、3、4、bbbb4次再灌注失败[改良脑梗死溶栓评分（mTICI） 0-2a]和再灌注成功[mTICI， 2b/3] 6组。主要结果是90天mRS评分为0-3。次要结局包括mRS 0-4、90天死亡率、48小时症状率（sICH）和任何颅内出血（aICH）。结果：共分析447例患者。388例再灌注成功，59例再灌注失败。前3次再灌注成功增加了功能预后良好的几率[尝试1:aOR， 4.454 (1.723-11.514),p=0.002；2: aOR, 3.762 (1.437-9.847),p=0.07；或3:aOR， 3.619 (1.254-10.440),p=0.017]， 90天死亡率降低[(尝试1:aOR， 0.336 (0.155-0.727),p=0.006；2: aOR为0.346 (0.160 ~ 0.746),p=0.007；or = 0.395 (0.164 ~ 0.953),p=0.039]。较短的PT增加了良好功能结局的几率[aOR， 0.991 (0.985-0.997),p=0.002]。PT可以减少尝试次数与患者预后之间的关联。尝试次数与sICH或aICH之间没有相关性，而当尝试次数大于2次时，aICH或sICH的比例呈增加趋势。结论：在接受EVT的lcs患者中，前3次再灌注成功和较短的PT与良好的功能预后相关。然而，尝试次数与临床结果之间的关联效应大小可能随着PT的延长而逐渐降低。

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 Neuroradiology 医学-核医学

CiteScore

6.10

自引率

5.70%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.