Clinical prognosis and timing of endovascular treatment for minor stroke patients with acute anterior circulation large vessel occlusive

doi:10.11817/j.issn.1673-9248.2023.05.004

Abstract

Abstract:

Objective

To investigate the efficacy, safety, and prognostic factors of endovascular treatment (EVT) in patients with minor stroke caused by acute anterior circulation large vessel occlusion (LVO), and to further compare the clinical prognosis of operation at different times.

Methods

A total of 177 patients with minor stroke with acute anterior circulation LVO and National Institutes of Health Stroke Scale (NIHSS) score ≤5, admitted to the Stroke Center of Department of Neurology, Linyi people's Hospital from January 2020 to March 2022 were consecutively collected in our study. According to the initial treatment regimen, 177 patients were divided into the direct endovascular treatment group (39 cases) and the optimal drug treatment group (138 cases), and the clinical prognosis of the two groups of patients was compared. The patients (43 cases) who underwent endovascular remedial therapy after the deterioration after the optimal drug treatment were regarded as the remedial endovascular treatment group, And the efficacy and safety of patients in the two groups of patients with direct endovascular therapy and remedial endovascular therapy were compared. The primary endpoint events were the prognosis at 90 days after treatment [modified Rankin scale (mRS) score ≤2], and secondary endpoint events were early neurological deterioration, symptomatic intracranial hemorrhage, and 90 d mortality. Based on the 90 d mRS score, all patients were divided into a good prognosis group (mRS score ≤2) and a poor prognosis group (mRS score >2) Univariate and multivariate logistic regression analysis was used to screen for factors affecting the prognosis of patients with minor stroke with acute anterior circulation LVO.

Results

Compared with the optimal drug treatment group, patients in the direct endovascular treatment group had a higher proportion of good prognosis of 90 days, and the difference was statistically significant (92.3% vs 78.3%, χ²=3.955, P=0.047). The proportion of early neurological deterioration was significantly reduced, and the difference was statistically significant (7.7% vs 41.3%, χ²=15.331, P<0.001). Patients treated with direct endovascular therapy had a significantly higher prognosis than remedial endovascular therapy (92.3% vs 74.4%, χ²=4.623, P=0.032). Direct endovascular therapy (OR=0.070, 95%CI: 0.013-0.382, P=0.002), and high collateral circulation grade (OR=0.096, 95%CI: 0.024-0.385, P=0.001) are independent influencing factors for EVT prognosis in patients with minor stroke caused by acute anterior circulation LVO.

Conclusion

Endovascular therapy is safe for patients with minor stroke caused by acute anterior circulation LVO. Early endovascular treatment for such patients can significantly improve the prognosis, and patients with a high grade of collateral circulation are more likely to benefit.

Key words: Large vessel occlusion, Mild stroke, Endovascular treatment

Hongyang Sun, Ji Liu, Zixiang Gong, Guangying Wang, Zhaoteng Ning, Xuan Zhao, Qiyi Zhu, Xianjun Wang. Clinical prognosis and timing of endovascular treatment for minor stroke patients with acute anterior circulation large vessel occlusive[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(05): 445-451.

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Figures/Tables 4

项目	直接EVT组（n=39）	最佳药物治疗组（n=138）	统计值	P值
男性[例（%）]	26（66.7）	82（59.4）	χ²=0.451	0.502
年龄（岁， $x ¯$ ±s）	62.90±9.30	62.77±10.22	t=-0.131	0.896
高血压史[例（%）]	26（66.7）	89（64.5）	χ²=0.063	0.802
糖尿病史[例（%）]	9（23.1）	33（23.9）	χ²=0.012	0.914
心房颤动史[例（%）]	1（2.6）	12（8.7）	χ²=0.900	0.342
吸烟史[例（%）]	10（25.6）	42（30.4）	χ²=0.337	0.562
饮酒史[例（%）]	10（25.6）	45（32.6）	χ²=0.689	0.406
静脉溶栓[例（%）]	14（35.9）	57（41.3）	χ²=3.171	0.075
发病至入院时间[h，M（Q_R）]	4（2，12）	5（2，8）	Z=-0.584	0.559
入院时NIHSS评分[分，M（Q_R）]	4（3，5）	4（2，5）	Z=-1.285	0.199
ASPECT评分[分，M（Q_R）]	8（7，9）	8（7，9）	Z=-0.305	0.761
90 d预后良好[例（%）]	36（92.3）	108（78.3）	χ²=3.955	0.047
早期神经功能恶化[例（%）]	3（7.7）	57（41.3）	χ²=15.331	＜0.001
症状性颅内出血[例（%）]	2（5.1）	5（3.6）	χ²=0.000	1.000
90 d死亡[例（%）]	1（2.6）	2（1.4）	χ²=0.000	1.000

项目	直接EVT组（n=39）	最佳药物治疗组（n=138）	统计值	P值
男性[例（%）]	26（66.7）	82（59.4）	χ²=0.451	0.502
年龄（岁， $x ¯$ ±s）	62.90±9.30	62.77±10.22	t=-0.131	0.896
高血压史[例（%）]	26（66.7）	89（64.5）	χ²=0.063	0.802
糖尿病史[例（%）]	9（23.1）	33（23.9）	χ²=0.012	0.914
心房颤动史[例（%）]	1（2.6）	12（8.7）	χ²=0.900	0.342
吸烟史[例（%）]	10（25.6）	42（30.4）	χ²=0.337	0.562
饮酒史[例（%）]	10（25.6）	45（32.6）	χ²=0.689	0.406
静脉溶栓[例（%）]	14（35.9）	57（41.3）	χ²=3.171	0.075
发病至入院时间[h，M（Q_R）]	4（2，12）	5（2，8）	Z=-0.584	0.559
入院时NIHSS评分[分，M（Q_R）]	4（3，5）	4（2，5）	Z=-1.285	0.199
ASPECT评分[分，M（Q_R）]	8（7，9）	8（7，9）	Z=-0.305	0.761
90 d预后良好[例（%）]	36（92.3）	108（78.3）	χ²=3.955	0.047
早期神经功能恶化[例（%）]	3（7.7）	57（41.3）	χ²=15.331	＜0.001
症状性颅内出血[例（%）]	2（5.1）	5（3.6）	χ²=0.000	1.000
90 d死亡[例（%）]	1（2.6）	2（1.4）	χ²=0.000	1.000

项目	直接EVT组（n=39）	补救EVT组（n=43）	统计值	P值
入院至穿刺时间[h，M（Q_R）]	2.0（1.5，2.5）	6.0（11.0，26.0）	Z=-6.634	＜0.001
术前NIHSS评分[分，M（Q_R）]	4（3，5）	11（8，14）	Z=-7.731	＜0.001
病变部位[例（%）]
串联病变	3（7.7）	5（11.6）	χ²=0.052	0.820
颈动脉颅内	7（17.9）	6（14.0）	χ²=0.245	0.621
大脑中动脉	28（71.8）	30（69.8）	χ²=0.041	0.840
大脑前动脉	1（2.6）	2（4.7）	χ²=0.000	1.000
病变机制[例（%）]			χ²=0.000	1.000
动脉粥样硬化病变	35（89.7）	39（90.7）
心源性栓塞	4（10.3）	4（9.3）
侧支循环3~4级[例（%）]	35（89.7）	34（79.1）	χ²=1.747	0.186
术后mTICI分级[例（%）]			χ²=0.000	1.000
＜2b级	2（5.1）	2（4.7）
≥2b级	37（94.9）	41（95.3）
90 d预后良好[例（%）]	36（92.3）	32（74.4）	χ²=4.623	0.032
症状性颅内出血[例（%）]	2（5.1）	3（7.0）	χ²=0.000	1.000
90 d死亡[例（%）]	1（2.6）	2（4.7）	χ²=0.000	1.000

项目	预后良好组（n=144）	预后不良组（n=33）	统计值	P值
男性[例（%）]	88（61.1）	20（60.6）	χ²=0.134	0.715
年龄（岁， $x ¯$ ±s）	62.8±9.74	62.8±11.23	t=0.784	0.996
高血压史[例（%）]	93（64.6）	22（66.7）	χ²=0.051	0.821
糖尿病史[例（%）]	33（22.9）	9（27.3）	χ²=0.281	0.596
心房颤动史[例（%）]	12（8.3）	1（3.0）	χ²=0.467	0.494
吸烟史[例（%）]	41（28.5）	11（33.3）	χ²=0.306	0.580
饮酒史[例（%）]	45（31.3）	10（30.3）	χ²=0.011	0.916
发病至入院时间[h，M（Q_R）]	5（2，8）	5（2，13）	Z=-0.355	0.723
入院NHISS评分[分，M（Q_R）]	4（2，5）	4（3，5）	Z=-1.598	0.110
静脉溶栓[例（%）]	57（39.6）	14（32.4）	χ²=0.729	0.393
EVT[例（%）]	68（47.2）	14（42.4）	χ²=0.249	0.618
直接EVT[例（%）]	36（25.0）	3（9.1）	χ²=3.955	0.047
侧支循环3~4级[例（%）]	125（86.8）	24（72.7）	χ²=3.996	0.046

项目	预后良好组（n=144）	预后不良组（n=33）	统计值	P值
男性[例（%）]	88（61.1）	20（60.6）	χ²=0.134	0.715
年龄（岁， $x ¯$ ±s）	62.8±9.74	62.8±11.23	t=0.784	0.996
高血压史[例（%）]	93（64.6）	22（66.7）	χ²=0.051	0.821
糖尿病史[例（%）]	33（22.9）	9（27.3）	χ²=0.281	0.596
心房颤动史[例（%）]	12（8.3）	1（3.0）	χ²=0.467	0.494
吸烟史[例（%）]	41（28.5）	11（33.3）	χ²=0.306	0.580
饮酒史[例（%）]	45（31.3）	10（30.3）	χ²=0.011	0.916
发病至入院时间[h，M（Q_R）]	5（2，8）	5（2，13）	Z=-0.355	0.723
入院NHISS评分[分，M（Q_R）]	4（2，5）	4（3，5）	Z=-1.598	0.110
静脉溶栓[例（%）]	57（39.6）	14（32.4）	χ²=0.729	0.393
EVT[例（%）]	68（47.2）	14（42.4）	χ²=0.249	0.618
直接EVT[例（%）]	36（25.0）	3（9.1）	χ²=3.955	0.047
侧支循环3~4级[例（%）]	125（86.8）	24（72.7）	χ²=3.996	0.046

因素	偏回归系数	Wald值	标准误	OR值	95%CI	P值
直接血管内治疗	-2.656	9.447	0.864	0.070	0.013~0.382	0.002
侧支循环等级3~4级	-2.345	10.935	0.709	0.096	0.024~0.385	0.001

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