Reperfusion-dependent treatment effects of thrombectomy in patients with large ischemic infarcts.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-10-07 DOI:10.1177/17474930251387613

Lukas Meyer, Susanne Gellißen, Götz Thomalla, Martin Bendszus, Gabriel Broocks, Matthias Bechstein, Christian Thaler, Fabien Subtil, Susanne Bonekamp, Anne Hege Aamodt, Blanca Fuentes, Elke Gizewski, Michael D Hill, Antonin Krajina, Laurent Pierot, Claus Ziegler Simonsen, Kamil Zelenak, Rolf Ankerlund Blauenfeldt, Bastian Cheng, Angelique Denis, Hannes Deutschmann, Franziska Dorn, Fabian Flottmann, Johannes Gerber, Mayank Goyal, Jozef Haring, Christian Herweh, Silke Hopf-Jensen, Vi Tuan Hua, Märit Jensen, Andreas Kastrup, Fee Keil, Andrej Klepanec, Egon Kurča, Ronni Mikkelsen, Markus Möhlenbruch, Stefan Müller-Hülsbeck, Nico Münnich, Paolo Pagano, Panagiotis Papanagiotou, Gabor Petzold, Mirko Pham, Volker Puetz, Jan Raupach, Gernot Reimann, Peter Ringleb, Maximilian Schell, Eckhard Schlemm, Silvia Schönenberger, Bjørn Tennøe, Christian Ulfert, Katerina Valis, Eva Vitkova, Dominik F Vollherbst, Wolfgang Wick, Jens Fiehler, Helge Kniep

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引用次数: 0

Abstract

Background: While thrombectomy benefits patients with large infarcts, it is unclear whether this benefit persists across different levels of reperfusion.

Aims: This study investigates how the degree of reperfusion influences the effectiveness of endovascular thrombectomy (EVT) combined with best medical treatment (BMT), compared to BMT alone, in patients with large infarcts.

Methods: This post-hoc analysis of the TENSION trial, a randomized controlled study, assessed EVT versus BMT in patients with extensive infarction (Alberta Stroke Program Early CT-Score [ASPECTS] 3-5).Primary outcome was the modified Rankin Scale (mRS) score at 90-days. Secondary outcomes included infarct volume at 24 hours, mortality, and symptomatic hemorrhage. Outcomes were stratified by final reperfusion level, measured with the modified thrombolysis in cerebral infarction (mTICI) scale. Confounder-adjusted common odds ratios (cOR) and average treatment effects (ATE) were estimated using inverse probability weighting with regression adjustment.

Results: A total of 246 patients (median age, 74 years [IQR, 65-80]; median baseline ASPECTS, 4 [IQR, 3-5]) were included. Compared to BMT alone, unsuccessful EVT (mTICI≤2a) was not associated with worse functional outcomes (cOR:1.2, 95%-CI, 0.95 to 1.52; P=.131), higher mortality (ATE:-11.6%; 95%-CI, -28.82 to 5.61; P=.187), or larger infarct volumes on follow-up (ATE:0.99 mL; 95%-CI, -45.30 to 45.32; P=.965). First-pass complete reperfusion (mTICI 3) showed the greatest treatment benefit, significantly improving all endpoints, with a cOR of 4.85 (95% CI, 3.74-6.31; P<.001) for improved mRS scores and a 29% absolute reduction in mortality.

Conclusion: In this post-hoc analysis of the TENSION trial, unsuccessful EVT did not worsen outcomes compared to BMT alone. The highest benefit of EVT occurred with first-pass complete reperfusion, emphasizing the importance of achieving optimal reperfusion in this vulnerable stroke subgroup. These findings do not justify general treatment recommendations.

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大范围缺血性梗死患者取栓的再灌注依赖性治疗效果。

背景：虽然取栓对大面积梗死患者有益，但尚不清楚这种益处是否在不同水平的再灌注中持续存在。目的：本研究探讨再灌注程度对大梗死患者血管内取栓术（EVT）联合最佳药物治疗（BMT）的效果的影响，与单纯BMT相比。方法：对张力试验进行事后分析，这是一项随机对照研究，评估了广泛梗死患者的EVT与BMT（阿尔伯塔卒中计划早期ct评分[ASPECTS] 3-5）。主要终点是90天的改良Rankin量表（mRS）评分。次要结局包括24小时梗死体积、死亡率和症状性出血。采用改良脑梗死溶栓（mTICI）量表对最终再灌注水平进行分层。采用回归校正的逆概率加权法估计混杂因素校正后的常见优势比（cOR）和平均治疗效果（ATE）。结果：共纳入246例患者（中位年龄为74岁[IQR， 65-80]；中位基线方面为4 [IQR， 3-5]）。与单独行BMT相比，不成功的EVT （mTICI≤2a）与较差的功能结局（cOR:1.2, 95%-CI, 0.95 ~ 1.52； P= 0.131）、较高的死亡率（ATE:-11.6%; 95%-CI, -28.82 ~ 5.61； P= 0.187）或随访时较大的梗死面积（ATE:0.99 mL; 95%-CI, -45.30 ~ 45.32； P= 0.965）无关。第一次完全再灌注（mTICI 3）显示出最大的治疗益处，显着改善了所有终点，其cOR为4.85 （95% CI, 3.74-6.31）。结论：在张力试验的这项后期分析中，与单独的BMT相比，不成功的EVT没有恶化预后。EVT的最大益处发生在首次完全再灌注时，这强调了在这一易感卒中亚组中实现最佳再灌注的重要性。这些发现并不能证明一般治疗建议的合理性。

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

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.