TY - JOUR T1 -晚期前大血管闭塞伴卒中前残疾的血管内vs医疗管理JF -神经学JO -神经学SP - e751 LP - e763 DO - 10.1212/WNL.0000000000201543半岛投注体育官网六世- 100 - 7非盟- James e . Siegler AU -默罕默德·m·库雷希AU -劳尔•g . Nogueira盟Kanta田中盟的帕特里克•米歇尔-西蒙·内格尔盟盟-尼古拉斯警员盟Marc日博盟- Hiroshi Yamagami盟Shinichi Yoshimura AU -穆罕默德Abdalkader AU - c•迪奥戈Haussen盟马哈茂德·h·Mohammaden AU -普Nannoni AU -马库斯·a·Mohlenbruch盟(婆婆Henon AU -苏尼尔•a . Sheth盟-圣地亚哥Ortega-Gutierrez AU -玛尔塔Olive-Gadea AU -弗朗索瓦•Caparros盟Fatih克朗盟-赛义德·扎伊迪盟艾丽西娅·c·卡斯顿圭AU - Kazutaka田盟Nobuyuki酒井法子AU -特s宫盟盟Mudassir Farooqui其它丰田章男非盟-塞尔吉奥Salazar-Marioni盟东竹内非盟-法拉兹-法曾签署盟Hesham大肠Masoud盟安娜路易莎库恩正文森本晃司AU - Ameena Rana盟盟- Masunari Shibata盟佐藤野中郁次郎AU -皮尔斯·克莱因盟Anvitha Sathya AU -妮可·l·凯利- AU -夏洛特Cordonnier AU -大卫。Strambo盟Jelle Demeestere盟-彼得·a . Ringleb盟-丹尼尔·罗伊AU -奥萨马O。Zaidat AU - Tudor G. Jovin AU - Johannes Kaesmacher AU - Urs Fischer AU - Jean Raymond AU - Thanh N. Nguyen Y1 - 2023/02/14 UR - http://n.半岛投注体育官网neurology.org/content/100/7/e751.abstract N2 -背景和目标目前的指南并没有针对先前存在改良Rankin评分(mRS)的大血管闭塞(LVO)患者在延长时间窗内(>上一次观察良好[TLSW]后6小时)进行机械取栓(MT)的建议;1.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)。 In both MV logistic regression and IPTW analysis, MT was associated with higher odds of ROR (adjusted OR [aOR] 3.96, 95% CI 1.78–8.79 and OR 3.10, 95% CI 1.20–7.98, respectively). 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 ER -