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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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Background and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT.
Methods We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b- 3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0?2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447).
Results Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients.
Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies.
Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
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참고문헌 (52)
참고문헌 신청
Adams HP Jr / 1993 / Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment / Stroke 24:35~41
Campbell BCV / 2019 / Ischaemic stroke / Nat Rev Dis Primers 5:70
Mustard JF / 1962 / Factors influencing thrombus formation in vivo / Am J Med 33:621~647
Deykin D / 1967 / Thrombogenesis / N Engl J Med 276:622~628
Mistry EA / 2017 / Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients : a meta-analysis / Stroke 48:2450~2456
Campbell BCV / 2019 / Ischaemic stroke / Nat Rev Dis Primers 5:70
Mustard JF / 1962 / Factors influencing thrombus formation in vivo / Am J Med 33:621~647
Deykin D / 1967 / Thrombogenesis / N Engl J Med 276:622~628
Mistry EA / 2017 / Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients : a meta-analysis / Stroke 48:2450~2456
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