对出现轻微症状的基底动脉闭塞进行再灌注治疗。

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-08-20 DOI:10.1177/23969873241272517

Ghil Schwarz, Angelo Cascio Rizzo, Marius Matusevicius, Tiago Moreira, Aleksandras Vilionskis, Andrea Naldi, Nicolas Martinez-Majander, Guido Bigliardi, Danilo Toni, Christine Roffe, Elio Clemente Agostoni, Niaz Ahmed

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引用次数: 0

摘要

简介：血管内治疗（EVT）可改善具有中重度症状的基底动脉闭塞（BAO）的治疗效果。然而，轻度症状（NIHSS 评分 0-10 分和 0-5 分）的最佳治疗方法仍不明确。本研究对轻度症状的 BAO 患者进行了 EVT ± IVT 与单纯 IVT 的比较：从 SITS 国际卒中治疗登记册中，我们纳入了 2013 年至 2021 年期间有基线 NIHSS 评分、在症状出现 6 小时内接受过 EVT、IVT 或两者治疗的 BAO 患者。我们采用双重稳健法（倾向评分匹配加多变量逻辑回归）分析了NIHSS评分为0-10分和0-5分的BAO患者接受EVT±IVT治疗与单独接受IVT治疗的疗效（3个月mRS）和安全性（SICH和3个月死亡）：结果：共纳入1426名患者。对于 NIHSS 评分为 0-10 分（180 例匹配，比例为 1:1）的患者，EVT ± IVT 组和单纯 IVT 组的结果相似。对于NIHSS评分0-5分（89例匹配，1:1比例），EVT±IVT组与单纯IVT组相比预后较差（mRS 0-2，aOR 0.20 [95% CI 0.06-0.61]；p = 0.005；mRS 0-3，aOR 0.27 [95% CI 0.08-0.89]；p = 0.031），但安全性预后相似：讨论：在早期治疗的轻度症状（定义为 NIHSS 0-10）BAO 患者中，EVT ± IVT 和单独 IVT 的疗效无显著差异。然而，对于症状非常轻微（定义为 NIHSS 0-5）的患者，与 EVT ± IVT 相比，单纯 IVT 的疗效更好：结论：随机试验对于确定症状轻微的 BAO 患者的最佳再灌注疗法至关重要。

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Reperfusion treatment in basilar artery occlusion presenting with mild symptoms.

Introduction: Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0-10 and 0-5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.

Patients and methods: From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0-10 and 0-5.

Results: 1426 patients were included. For NIHSS scores 0-10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0-5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0-2, aOR 0.20 [95% CI 0.06-0.61]; p = 0.005; mRS 0-3, aOR 0.27 [95% CI 0.08-0.89]; p = 0.031), but safety outcomes were similar.

Discussion: In early-treated BAO patients with mild symptoms, defined as NIHSS 0-10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0-5, IVT alone was associated with better outcomes compared to EVT ± IVT.Conclusion: Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.