% 0期刊文章%一个默罕默德·m·库雷希James e . Siegler % %劳尔·g·Nogueira % Kanta田中%的帕特里克•米歇尔•西蒙内格尔% %尼古拉斯义务警员% Marc日博%一个Hiroshi Yamagami % Shinichi Yoshimura %穆罕默德Abdalkader % c•迪奥戈Haussen %马哈茂德·h·Mohammaden %一个普Nannoni %马库斯·A·Mohlenbruch %(婆婆Henon %一个圣地亚哥Ortega-Gutierrez苏尼尔•A . Sheth % %一弗朗索瓦•Caparros Marta Olive-Gadea % %一个赛义德·扎伊迪Fatih克朗% %艾丽西娅·c·卡斯顿圭% Kazutaka田%Nobuyuki酒井法子%一个特s宫% % Mudassir Farooqui其它丰田%竹内塞吉奥Salazar-Marioni %一个东%一个法拉兹-法曾签署% Hesham大肠Masoud %安娜路易莎库恩正文森本晃司% Ameena Rana % %一个佐藤野中郁次郎Masunari Shibata % %一个皮尔斯·克莱因% Anvitha Sathya %一个夏洛特Cordonnier妮可·l·凯利- % %的Davide Strambo % Jelle Demeestere %一个彼得•丹尼尔Roy A . Ringleb % %奥萨马o . Zaidat %都铎g·Jovin % Johannes Kaesmacher %一个一致的费舍尔%牛仔裤雷蒙德% Thanh N。晚期前大血管闭塞伴卒中前残疾的血管内治疗vs内科治疗%B CLEAR和RESCUE-Japan的分析%D 2023 %R 10.1212/WNL。背景与目的目前的指南并没有针对先前存在改半岛投注体育官网良兰金量表(mRS) >的大血管闭塞(LVO)患者，在较长的时间窗内(>距离上次观察良好时间[TLSW] 6小时后)推荐机械取栓(MT)。在本研究中，我们评估了急性LVO 6- 24小时时间窗内卒中前残疾患者的MT与医疗管理的结果。方法我们分析了一项多国队列研究(2014年至2020年，6个国家，61个地点)，研究对象为中风前(或基线)mRS 2至4，前循环LVO治疗6 - 24小时的TLSW患者。采用多变量logistic回归和治疗加权反概率(IPTW)比较在延长时间窗内接受MT治疗与内科治疗的患者。主要结果为Rankin恢复(ROR，卒中前mRS恢复90天)。结果纳入554例患者(448例接受MT)，中位年龄为82岁(四分位范围[IQR] 72-87)，美国国立卫生研究院卒中量表(NIHSS)为18岁(IQR 13-22)。在MV logistic回归和IPTW分析中，MT与较高的ROR几率相关(校正OR [aOR] 3.96, 95% CI 1.78-8.79和OR 3.10, 95% CI 1.20-7.98)。 Among other factors, premorbid mRS 4 was associated with higher odds of ROR (aOR, 3.68, 95% CI 1.97–6.87), while increasing NIHSS (aOR 0.90, 95% CI 0.86–0.94) and decreasing Alberta Stroke Program Early Computed Tomography Scale score (aOR per point 0.86, 95% CI 0.75–0.99) were associated with lower odds of ROR. Age, intravenous thrombolysis, and occlusion location were not associated with ROR.Discussion In patients with preexisting disability presenting in the 6- to 24-hour time window, MT is associated with a higher probability of returning to baseline function compared with medical management.Classification of Evidence This investigation's results provide Class III evidence that in patients with preexisting disability presenting 6–24 hours from the TLSW and acute anterior LVO stroke, there may be a benefit of MT over medical management in returning to baseline function.ASPECTS=Alberta Stroke Program Early Computed Tomography Scale; CLEAR=CT for Late Endovascular Reperfusion; IPTW=inverse probability of treatment weighting; IQR=interquartile range; IVT=intravenous thrombolysis; LVO=large vessel occlusion; MCA=middle cerebral artery; mRS=modified Rankin Scale; MT=mechanical thrombectomy; MV=multivariable; NIHSS=National Institutes of Health Stroke Scale; PS=propensity score; RESCUE-Japan Registry 2=Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2; ROR=return of Rankin; SMR=standardized mortality ratio; TLSW=time last seen well; UW=utility weighted %U //www.ebmtp.com/content/neurology/100/7/e751.full.pdf