Direct endovascular treatment may be more appropriate for patients with good collateral circulation: a retrospective case-control study
Notice bibliographique
Résumé
Background: Recent studies have shown that endovascular treatment (EVT) alone is noninferior to the combination of intravenous thrombolysis and EVT (IVT + EVT) in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the anterior cerebral circulation. However, some studies report conflicting results suggesting that the benefits of IVT may be limited to specific subgroups. Previous research has established a strong correlation between collateral status and prognosis in patients treated with IVT or EVT. The primary aim of this study was to investigate the impact of collateral status on clinical outcomes in patients receiving EVT alone or IVT + EVT. Methods: We retrospectively collected data from 238 consecutive patients who were diagnosed with AIS-LVO and underwent EVT or IVT + EVT from January 2019 to January 2023. Patients were divided into two groups, based on whether they received IVT prior to EVT. Multivariable ordinal logistic regression with an interaction term was used to assess the impact of collateral circulation on treatment outcomes, including 90-day modified Rankin Scale (mRS) scores, success rate of recanalization, incidence of intracerebral hemorrhage, mortality, embolus migration, and the rate of achieving a modified thrombolysis in cerebral infarction (mTICI) score of 3. To adjust the common odds ratio (OR), we included variables such as gender, age, baseline National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and onset-to-puncture time. Results: Overall, patients with adequate collateral circulation, defined as a regional leptomeningeal collateral score of 17-20 points, demonstrated more favorable 90-day outcomes, including lower mRS score, higher recanalization success rate, and lower rates of intracerebral hemorrhage, mortality, embolus migration, along with higher likelihood of achieving mTICI 3 score. However, the impact of collateral circulation differed between the two groups. In the EVT group, improved collateral circulation was significantly associated with better outcomes [OR: 8.381, 95% confidence interval (CI): 2.120-46.695, P=0.006]. In the IVT + EVT group, improved collateral circulation was linked to better outcomes (OR: 3.157, 95% CI: 1.618-6.541, P=0.001), it was additionally associated with a higher mortality rate (OR: 0.334, 95% CI: 0.145-0.725, P=0.007), increased incidence of embolus escape (OR: 0.359, 95% CI: 0.130-0.894, P=0.033), and a reduced likelihood of mTICI 3 recanalization (OR: 0.460, 95% CI: 0.244-0.844, P=0.014). Conclusions: Better collateral circulation is associated with favorable 90-day outcomes in both EVT group and IVT + EVT group. However, in the IVT + EVT group better collateral circulation was also linked to a higher rate of mortality, increased incidence of embolus escape, and lower rate of mTICI 3 recanalization. This may suggest that AIS-LVO patients with better collateral circulation could benefit more from EVT alone. Future studies are warranted to confirm these findings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».