[Efficacy and safety of endovascular therapy after 24 h from ischemic stroke onset in patients with acute anterior circulation ischemic stroke].

Objective: To explore the effectiveness and safety of endovascular treatment (EVT) for patients with acute anterior circulation ischemic stroke with symptom onset exceeding 24 h. Methods: In this retrospective cohort study, data were extracted from patients who underwent endovascular treatment for acute anterior circulation ischemic stroke at the First Hospital of Jilin University from February 2019 to April 2022. A total of 569 patients were included, with a mean age of 63 (54-70) years. Among them, 398 (69.9%) were male. The patients were divided into two groups based on symptom onset time:>24 h group and≤24 h group. Propensity score matching (PSM) was used to match the patients in a 1︰1 ratio between the>24 h group and the≤24 h group. Logistic regression was used to evaluate the impact of symptom onset time on outcome events. Results: Before PSM, compared with≤24 h group, the>24 h group had a younger age [56 (48, 64) vs. 64 (55, 70), Z=-3. 60, P<0.001]; lower proportion of prior atrial fibrillation [1.8% (1/57) vs. 21.1% (108/512), χ2=12.39, P<0.001]; lower proportion of wake-up stroke [7.0% (4/57) vs. 27.7% (142/512), χ2=11.54, P<0.001]; lower baseline NIHSS score [11.0 (7.5, 14.0) vs. 13.0 (10.0, 16.0), Z=-3.22, P<0.001]; and a higher American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR) grading (P<0.001). After PSM, there were no significant differences in baseline characteristics between the two groups. There was no significant difference in the proportion of patients with a modified Rankin Scale (mRS) score≤2 at 90 days after surgery between the two groups (before matching: 42.0% vs. 40.4%, OR=0.745, 95%CI 0.407-1.362, P=0.339; after matching: 51.8% vs. 39.3%, OR=0.511, 95%CI 0.212-1.236, P=0.136). No significant differences were observed in the incidence of any safety outcomes between the>24 h group and the≤24 h group. Conclusion: For patients with acute anterior circulation ischemic stroke with symptom onset exceeding 24 h, EVT is feasible after strict radiological screening and has similar safety and effectiveness as for patients with symptom onset under 24 h.目的： 探讨发病时间超 24 h的急性前循环缺血性卒中患者血管内治疗的有效性与安全性。 方法： 回顾性队列研究。回顾分析2019年2月至2022年4月于吉林大学第一医院接受血管内治疗的急性前循环缺血性卒中患者569例。平均年龄63（54~70）岁，男性398例（69.9%）。根据患者发病时间将其分为发病时间>24 h组及发病时间≤24 h组，采用倾向得分匹配（PSM）的方法将发病时间>24 h的患者及发病时间≤24 h的患者以1∶1的比例进行匹配。使用logistic回归评估发病时间对结局事件的影响。 结果： PSM匹配前，发病时间>24 h组的年龄更低［56（48，64）比64（55，70）岁，Z=-3.60，P<0.001］、房颤比例更低［1.8%（1/57）比21.1%（108/512），χ2=12.39，P<0.001］、觉醒卒中比例更低［7.0%（4/57）比27.7%（142/512），χ2=11.54，P<0.001］、基线NIHSS评分更低［11.0（7.5，14.0）比13.0（10.0，16.0）分，Z=-3.22，P<0.001］、ASITN/SIR侧支循环分级更高（P<0.001）。使用PSM方法将2组患者匹配后，基线指标差异无统计学意义。PSM匹配前及匹配后，2组患者术后90 d的改良Rankin量表（mRS）评分≤2分比例（匹配前：42.0% 比 40.4%，OR=0.745，95%CI 0.407~1.362，P=0.339；匹配后：51.8% 比 39.3%，OR=0.511，95%CI 0.212~1.236，P=0.136），差异无统计学意义。2组患者安全性结局，差异无统计学意义。 结论： 对于发病时间>24 h的急性前循环缺血性卒中患者，经过严格影像学筛选后接受血管内治疗是可行的，安全性与有效性与发病时间≤24 h内的患者相似。.