[Safety and effectiveness of emergency stenting for acute anterior circulation large artery disease].

Objective: To explore the safety and effectiveness of early stent implantation in patients with acute anterior circulation large artery disease. Methods: Patients were recruited from the RESCUE-RE study (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization). Patients who were diagnosed with acute ischemic stroke within 24 hours of onset and given endovascular treatment after consultation from July 2018 to May 2019 from 18 sub-centers nationwide were retrospectively enrolled. According to whether the stents were placed during the operation, the patients were divided into two groups: stenting group and non-stenting group. The baseline between the two groups was matched by propensity score. The matching variables included age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline Glasgow Coma Scale (GCS) score, history of stroke, smoking and onset to hospital time. The primary clinical outcome was 90-day good neurological outcome [defined as modified Rankin score (mRS) 0-2]. Secondary outcomes include 90-day mortality, 24-hour re-occlusion of the responsible artery, and symptomatic intracranial hemorrhage. The differences in clinical endpoints between the two groups were compared. Result: A total of 899 patients with acute anterior circulation artery stenosis or occlusion were included in the study, with a mean age of(66±12)years,and 532(59.18%) were male. There were 193 patients in the stenting group and 706 patients in the non-stenting group. After the baseline data between the two groups were matched by propensity score, 169 patients were enrolled in each of two groups respectively. After matching, the proportion of patients in the stenting group with etiological diagnosis of large atherosclerosis [82.53% (137/166) vs 55.69% (93/167)] and the proportion of patients with previous history of hypertension [63.31% (107/169) vs 47.93% (81/169)] in the stenting group were higher than those in the non-stenting group (both P<0.05). While the proportion of patients in the non-stenting group with cardiogenic embolism [37.73%(63/167) vs 11.45%(19/166)]and the proportion of patients with atrial fibrillation [18.93% (32/169) vs 10.65%(18/169)]was higher(all P<0.05). In the stenting group, the time from onset to recanalization was longer[519 (408, 620)min vs 469 (365, 690)min], and the proportion of general anesthesia [50.89% (86/169) vs 35.50% (60/169)] was higher in the stenting group(both P<0.05). In addition, in the stenting group, the proportion of patients receiving mechanical thrombectomy[67.46% (114/169) vs 88.76% (150/169)] and arterial thrombolysis [2.37% (4/169) vs 18.93% (32/169)] was lower than non-stenting group during the operation, while the proportion of patients receiving balloon dilation [53.85% (91/169) vs 13.61% (23/169)]was higher(both P<0.05). The proportion of patients in stent group receiving antiplatelet drugs before operation was higher [13.46% (21/169) vs 8.70% (14/169)](both P<0.05). In terms of clinical outcome, compared with the non-stenting group, the proportion of patients in the stenting group with good neurological function in 90 days was lower [44.79% (73/169) vs 56.36% (93/169)], and the proportion of death at 90 days was higher[15.98% (27/169) vs 8.88% (15/169)] (both P<0.05). There was no significant difference between the two groups in 24-hour re-occlusion[8.88% (15/169) vs 9.47% (16/169)] and symptomatic intracranial hemorrhage[5.92% (10/169) vs 4.76% (8/169)](both P>0.05). Conclusion: For patients with acute anterior circulation artery disease, early stent therapy may increase the proportion of patients with adverse neurological outcomes.目的： 探讨急性前循环大动脉病变患者早期支架置入治疗的安全性和有效性。 方法： 入组患者来源于急重症缺血性卒中血管再通治疗后监测与管理的队列研究（RESCUE-RE）。回顾性入组2018年7月至2019年5月来自全国18家分中心发病在24 h内、诊断为急性缺血性卒中且经过会诊后给予急性血管内治疗的患者。根据术中是否给予支架置入分为两组，支架治疗组和非支架治疗组。两组之间基线采用倾向性评分进行匹配，匹配变量包括年龄、性别、基线美国国立卫生研究院卒中量表（NIHSS）评分、基线格拉斯哥昏迷量表（GCS）评分、既往卒中病史、吸烟史和发病至到院时间。主要临床终点为90 d良好神经功能预后［定义为改良Rankin 评分（mRS）0~2分］。次要终点包括90 d病死率、24 h责任动脉再闭塞率和症状性颅内出血。比较两组间临床终点的差异。 结果： 研究共纳入899例急性前循环大动脉狭窄或闭塞患者，年龄（66±12）岁，532例（59.18%）为男性患者。其中支架治疗组为193例，非支架治疗组为706例。两组之间基线资料经过倾向性评分匹配后分别纳入169例患者。匹配后支架治疗组患者病因诊断为大动脉粥样硬化比例［82.53%（137/166）比55.69%（93/167）］和既往合并高血压病史患者比例［63.31%（107/169）比47.93%（81/169）］高于非支架治疗组（均P<0.05），而非支架治疗组患者心源性栓塞比例［37.73%（63/167）比11.45%（19/166）］和既往合并房颤比例［18.93%（32/169）比10.65%（18/169）］高于支架治疗组（均P<0.05）。与非支架治疗组比较，支架治疗组患者发病至血管再通时间更长［M（Q1，Q3）］［519（408，620）min比469（365，690）min］，全麻比例更高［50.89%（86/169）比35.50%（60/169）］（均P<0.05）。此外，与非支架治疗组比较，支架治疗组患者术中合并给予机械取栓［67.46%（114/169）比88.76%（150/169）］和动脉溶栓［2.37%（4/169）比18.93%（32/169）］比例更低，而给予球囊扩张比例更高［53.85%（91/169）比13.61%（23/169）］，术前给予抗血小板药物治疗比例更高［13.46%（21/169）比8.70%（14/169）］（均P<0.05）。临床结局方面，匹配后两组比较，与非支架治疗组相比，支架治疗组患者90 d良好神经功能预后比例更低［44.79%（73/169）比56.36%（93/169）］，90 d死亡比例更高［15.98%（27/169）比8.88%（15/169）］（均P<0.05）。而24 h血管再闭塞［8.88%（15/169）比9.47%（16/169）］、症状性颅内出血［5.92%（10/169）比4.76%（8/169）］两组之间比较差异无统计学意义（均P>0.05）。 结论： 对于急性前循环大动脉狭窄或闭塞的患者，早期支架治疗可能增加患者不良神经功能预后的比例。.