Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-07-31 DOI:10.1227/neu.0000000000003669

Alice Hsu, Bachar El Baba, Sheila Eshraghi, Francesca Giraudo, Sepehr Saberian, Reda Chalhoub, Ali Alawieh, Zvipo Chisango, Brian M Howard, Alejandro M Spiotta, Mohammad-Mahdi Sowlat, Frank Tong, Feras Akbik, Aqueel Pabaney, Pascal Jabbour, Stavropoula I Tjoumakaris, Ilko L Maier, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Benjamin Gory, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Joon-Tae Kim, Shinichi Yoshimura, Peter Kan, Reade De Leacy, Isabel Fragata, Adam Polifka, Joshua W Osbun, Richard Williamson, Roberto Javier Crosa, Michael R Levitt, Mark Moss, Min S Park, Walter Casagrande, Charles Matouk, Shakeel A Chowdhry, C Michael Cawley, Jonathan A Grossberg

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引用次数: 0

Abstract

Background and objectives: Despite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion.

Methods: Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021. Patients were included based on thrombus location and categorized into intracranial internal carotid artery (ICA), ICA + MCA, ICA + ACA, or MCA + ACA cohorts. The primary outcome was 90-day functional independence, defined as a modified Rankin Score (mRS) of 0-2. Secondary outcomes included successful recanalization, procedure time, and rates of postprocedural hemorrhage.

Results: In total, 2067 patients were included in the study with 83 patients (4%) having concurrent MCA + ACA occlusions. There were no differences in age, comorbidities, or intravenous thrombolysis use between the ICA and MCA + ACA groups. On univariate analysis, the MCA + ACA group had a significantly lower proportion of patients achieving mRS 0-2 at 90 days (12% vs 33%, P < .05) compared with the ICA groups. There were no differences in secondary technical outcomes between the 2 groups (P > .05); however, mortality was higher in the MCA + ACA group (22 vs 13%) (P < .05). On multivariate regression, MCA + ACA location was an independent predictor of lower odds of mRS 0-2 compared with the ICA group overall (adjusted odds ratio = 0.52, P = .048) and in patients with successful recanalization (adjusted odds ratio = 0.45, P = .035).

Conclusion: Despite similar vascular territories, concurrent occlusion of the MCA and ACA segments results in worse clinical outcomes compared with intracranial ICA occlusion.

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大脑前动脉和大脑中动脉同时闭塞可预测前循环卒中患者成功取栓后神经预后不良。

背景和目的：尽管急性缺血性卒中的血管内血栓切除术成功，但很大比例的患者表现出梗死核心快速和早期进展，并且在90天内未能实现功能独立。本研究的目的是评估血栓位置和侧支对并发大脑中动脉（MCA）和大脑前动脉（ACA）闭塞的潜在影响。方法：数据来自2015年至2021年间32个国际中心接受血管内血栓切除术的前循环卒中患者的多中心登记。根据血栓位置纳入患者，并将其分为颅内颈内动脉（ICA）、ICA + MCA、ICA + ACA或MCA + ACA组。主要终点是90天的功能独立性，定义为0-2的修正Rankin评分（mRS）。次要结果包括再通成功、手术时间和术后出血率。结果：共纳入2067例患者，其中83例（4%）合并MCA + ACA闭塞。ICA组和MCA + ACA组在年龄、合并症或静脉溶栓使用方面没有差异。单因素分析显示，与ICA组相比，MCA + ACA组在90天达到mRS 0-2的患者比例显著低于ICA组（12% vs 33%, P < 0.05）。两组间次要技术指标比较差异无统计学意义（P < 0.05）；然而，MCA + ACA组的死亡率更高（22% vs 13%）（P < 0.05）。在多因素回归中，与ICA组相比，MCA + ACA位置是mRS 0-2发生率较低的独立预测因子（校正优势比= 0.52,P = 0.048）和再通成功患者（校正优势比= 0.45,P = 0.035）。结论：尽管血管区域相似，但与颅内ICA闭塞相比，MCA和ACA段同时闭塞的临床结果更差。

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

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.