Marek Sykora, Sven Poli, Michael Giannakakis, Joshua Mbroh, Alexandra Gomez Exposito, Stefan Krebs, Alexandra Posekany, Mira Katan, Susanne Wegener, Gian Marco De Marchis, Thomas Gattringer, Hannes A Deutschmann, Lukas Mayer-Suess, Jens Fiehler, Ulrike Ernemann, Florian Hennersdorf, Tomas Dobrocky, Zsolt Kulcsár, Pasquale Mordasini, Marios Psychogios, Christian Loewe, Elke R Gizewski, Christian H Nolte, Christian Neumann, Urs Fischer, Julia Ferrari
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引用次数: 0
摘要
背景和目的：与最佳药物治疗（BMT）相比，血栓切除术是否能改善脑卒中合并颈动脉夹层（CAD）患者的预后尚不清楚。方法：这是一项国际观察性研究，基于前瞻性的奥地利、德国和瑞士全国卒中登记。根据治疗方式（取栓vs静脉溶栓）和入院时卒中严重程度NIH卒中量表（NIHSS）对CAD所致大血管闭塞（LVO）患者进行比较。结果：1023例患者（平均年龄54岁，72%男性）中，516例接受取栓，507例接受BMT。经过稳健调整后，NIHSS≥6的患者取栓与预后良好相关（校正风险比(aRR) = 1.77, 95% CI 1.44-2.17）。讨论：取栓改善了CAD所致LVO患者的功能结局，入院时NIHSS≥6，但未改善NIHSS。证据分类：本研究提供III类证据，对于入院时NIHSS≥6分的CAD所致LVO患者，取栓与BMT相比显著增加了有利结局的可能性。
Functional Outcome in Patients With Carotid Artery Dissection Undergoing Thrombectomy or Standard Medical Treatment.
Background and objectives: Whether thrombectomy compared with best medical treatment (BMT) improves outcome in patients with stroke and carotid artery dissection (CAD) is unknown.
Methods: This was an international observational study based on prospective nationwide Austrian, German, and Swiss stroke registries. Patients with large vessel occlusion (LVO) due to CAD were compared according to treatment modality (thrombectomy vs BMT including intravenous thrombolysis) and to admission stroke severity NIH Stroke Scale (NIHSS) <6 vs NIHSS ≥6. The primary outcome was the favorable functional outcome (modified Rankin Score 0-2) at 3 months.
Results: Of 1,023 patients (mean age 54 years, 72% males), 516 received thrombectomy and 507 received BMT. After robust adjustment, thrombectomy was associated with favorable outcome in patients presenting with NIHSS ≥6 (adjusted risk ratio (aRR) = 1.77, 95% CI 1.44-2.17). In those presenting with NIHSS <6, thrombectomy was associated with unfavorable outcome (aRR 1.68, CI 1.1-2.56) as compared with BMT.
Discussion: Thrombectomy improved functional outcome in patients with LVO due to CAD and admission NIHSS ≥6, but not NIHSS <6 points.
Classification of evidence: This study provides Class III evidence that for patients with LVO due to CAD and admission NIHSS ≥6 points, thrombectomy compared with BMT significantly increases the probability of favorable outcome.
期刊介绍：
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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