医学
颈内动脉
改良兰金量表
闭塞
置信区间
优势比
倾向得分匹配
脑出血
大脑中动脉
冲程(发动机)
血管内治疗
内科学
统计显著性
回顾性队列研究
外科
心脏病学
缺血性中风
动脉瘤
格拉斯哥昏迷指数
缺血
机械工程
工程类
作者
Daniel Kaiser,Tilman Reiff,Ulrich Mansmann,Daniela Schoene,Davide Strambo,Patrik Michel,Mohamad Abdalkader,Thanh N. Nguyen,Matthias Gawlitza,Markus Möhlenbruch,Peter A. Ringleb,Volker Puetz,Johannes Gerber,Simon Nagel
标识
DOI:10.1007/s00062-023-01342-7
摘要
The benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion.We conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale ≤ 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3‑month mortality.In total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84-4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3‑month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases.Although the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion.
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