RT杂志文章SR电子T1血管内vs卒中前残疾晚期前大血管闭塞的医疗管理JF神经学JO神经学FD Lippincott Williams & Wilkins SP e751 OP e763 DO 10.1212/WNL.0000000000201543半岛投注体育官网签证官100是7 A1 James e . Siegler A1穆罕默德·m·库雷希A1劳尔•g . Nogueira A1 Kanta田中A1西蒙内格尔A1的帕特里克•米歇尔A1尼古拉斯义务警员A1 Marc日博A1 Hiroshi Yamagami A1 Shinichi Yoshimura A1穆罕默德Abdalkader A1•迪奥戈c Haussen A1马哈茂德·h·Mohammaden A1普Nannoni A1马库斯·a·Mohlenbruch A1(婆婆Henon A1苏尼尔•a . Sheth A1圣地亚哥Ortega-Gutierrez A1 Marta Olive-Gadea A1弗朗索瓦Caparros A1 Fatih克朗A1赛义德·扎伊迪A1艾丽西娅·c·卡斯顿圭A1 Kazutaka田A1 Nobuyuki酒井法子A1丰田普瑞特的美国A1 Mudassir Farooqui A1其它A1 Sergio Salazar-Marioni A1东Takeuchi A1将核技术法拉兹-法曾A1 Hesham大肠Masoud A1安娜路易莎库恩A1 Ameena Rana A1 Masafumi森本晃司A1 Masunari柴田A1(野中郁次郎A1皮尔斯·克莱因A1 Anvitha Sathya A1妮可·l·凯利- A1夏洛特Cordonnier A1 (Davide Strambo A1 Jelle Demeestere A1彼得a Ringleb A1丹尼尔·罗伊A1奥萨马o . Zaidat A1都铎g . Jovin A1 Johannes Kaesmacher A1一致的费舍尔A1 Jean雷蒙德A1 Thanh n .阮年2023 UL http://n.半岛投注体育官网neurology.org/content/100/7/e751.abstract AB背景和目标目前的指南没有针对先前存在改良兰金量表(mRS) > 1的大血管闭塞(LVO)患者在延长时间窗(>6小时后最后一次观察良好[TLSW])内机械取栓(MT)的建议。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