最初的高国家卫生研究院卒中评分和任何颅内出血是急性大血管闭塞接受血栓切除术治疗的90岁老人预后不良的独立因素:急性血管内血栓切除术(TREAT)的东京/多玛注册研究

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2022-09-01 DOI:10.1016/j.wneu.2022.06.038

Masato Inoue , Takahiro Ota , Tetsuo Hara , Keigo Shigeta , Yuki Kamiya , Hideki Arakawa , Rie Aoki , Wataro Tsuruta , Masahiko Ichijo , Junya Kaneko , Yoshiaki Shiokawa , Teruyuki Hirano

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引用次数: 1

摘要

背景:机械取栓(MT)对于≥80岁伴有大血管闭塞(LVO)的急性缺血性脑卒中患者是有效的。然而，≥90岁患者的数据仍然非常有限，影响功能结局的因素尚不清楚。本研究旨在探讨≥90岁接受MT治疗急性LVO患者功能结局的影响因素。方法:本回顾性观察性研究采用东京/多玛急性血管内取栓(TREAT)研究的前瞻性数据。纳入标准如下:1)年龄≥90岁，接受MT治疗LVO的患者;2)卒中前改良Rankin量表(mRS)评分0-3分。功能结果根据术后90天mRS评分来定义:功能良好，mRS评分0-3分;功能差，mRS评分4-6分。结果对≥90岁的104例患者进行数据分析。25例患者(24.0%)功能预后良好，79例患者功能预后较差。在单变量分析中，美国国立卫生研究院卒中量表(NIHSS)的初始评分、改良溶栓治疗脑梗死2b-3级、改良溶栓治疗脑梗死3级以及任何颅内出血和出血性梗死均存在显著差异。多变量分析证实了初始NIHSS评分(优势比1.08;95%置信区间为1.01-1.17;P = 0.045)和颅内出血(优势比11.6;95%置信区间为1.43-95.0;P = 0.022)作为功能结局的独立因素。结论NIHSS初始评分高和颅内出血是≥90岁急性缺血性脑卒中患者接受MT治疗后功能预后差的独立因素。

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An Initial High National Institutes of Health Stroke Scale Score and Any Intracranial Hemorrhage Are Independent Factors for a Poor Outcome in Nonagenarians Treated with Thrombectomy for Acute Large Vessel Occlusion: The Tokyo/Tama-REgistry of Acute Endovascular Thrombectomy (TREAT) Study

Background

Mechanical thrombectomy (MT) is effective in acute ischemic stroke patients ≥80 years old with large vessel occlusion (LVO). However, data for patients ≥90 years old remain very limited, and factors influencing functional outcomes are unclear. This study aimed to investigate factors influencing functional outcomes in patients ≥90 years old treated with MT for acute LVO.

Methods

This retrospective observational study used prospectively collected data from the Tokyo/tama-REgistry of Acute endovascular Thrombectomy (TREAT) study. Inclusion criteria were as follows: 1) patients ≥90 years old treated with MT for LVO and 2) prestroke modified Rankin Scale (mRS) score, 0–3. The functional outcome was defined based on the mRS score at 90 days after the procedure: good functional outcome, mRS score 0–3 and poor functional outcome, mRS score 4–6.

Results

Data were analyzed for 104 patients ≥90 years old. The good functional outcome was observed in 25 patients (24.0%), and the poor functional outcome was observed in the remaining 79 patients. Significant differences were identified in initial National Institutes of Health Stroke Scale (NIHSS) score, modified Thrombolysis in Cerebral Infarction grade 2b-3, modified Thrombolysis in Cerebral Infarction grade 3, and any intracranial hemorrhage and hemorrhagic infarction in univariate analyses. Multivariable analysis confirmed the initial NIHSS score (odds ratio, 1.08; 95% confidence interval, 1.01–1.17; P = 0.045) and any intracranial hemorrhage (odds ratio, 11.6; 95% confidence interval, 1.43–95.0; P = 0.022) as independent factors for the functional outcome.

Conclusions

An initial high NIHSS score and any intracranial hemorrhage are independent factors for the poor functional outcome in acute ischemic stroke patients ≥90 years old treated with MT.

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS