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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors.
Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria).
Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3).
Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
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참고문헌 (24)
참고문헌 신청
Broderick JP / 2013 / Endovascular therapy after intravenous t-PA versus t-PA alone for stroke / N Engl J Med 368:893~903
Chimowitz MI / 2013 / Endovascular treatment for acute ischemic stroke—still unproven / N Engl J Med 368:952~955
Goyal M / 2016 / Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials / Lancet 387:1723~1731
Urra X / 2015 / Mechanical thrombectomy in and outside the REVASCAT trial : insights from a concurrent population-based stroke registry / Stroke 46:3437~3442
Nogueira RG / 2018 / Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct / N Engl J Med 378:11~21
Chimowitz MI / 2013 / Endovascular treatment for acute ischemic stroke—still unproven / N Engl J Med 368:952~955
Goyal M / 2016 / Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials / Lancet 387:1723~1731
Urra X / 2015 / Mechanical thrombectomy in and outside the REVASCAT trial : insights from a concurrent population-based stroke registry / Stroke 46:3437~3442
Nogueira RG / 2018 / Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct / N Engl J Med 378:11~21
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