摘要：

目的: 对比分析急性大血管闭塞患者超“时间窗”血管内治疗(EVT)联合最佳药物治疗(BMT)与单纯最佳药物治疗的长期预后。方法: 纳入2021年11月至2023年7月天津市环湖医院诊断与治疗的158例急性前循环大血管闭塞患者，分别予以血管内治疗联合最佳药物治疗(EVT组，70例)和单纯最佳药物治疗(BMT组，88例)，发病后12个月采用改良Rankin量表(mRS)评估神经功能预后，单因素和多因素Logistic回归分析筛查长期预后影响因素，倾向评分匹配和多重插补法行敏感性分析。结果: Logistic回归分析显示，血管内治疗是超“时间窗”急性大血管闭塞患者神经功能长期预后良好(mRS评分≤ 2分)的保护因素(OR=3.110，95% CI：1.460~6.620；P=0.003)，年龄增大(OR=0.955，95% CI：0.924~0.987；P=0.007)和高血压病史(OR=0.418，95% CI：0.187~0.936；P=0.034)是神经功能长期预后不良的危险因素。主要结局指标的敏感性分析，倾向评分匹配后分析数据集和多重插补后分析数据集均显示，EVT组患者发病后12个月预后良好率高于BMT组(倾向评分匹配后分析数据集：aOR=3.610，95% CI：1.370~9.550，P=0.010；多重插补后分析数据集：aOR=3.870，95% CI：1.780~8.440，P=0.000)，与主分析结果趋势一致。结论: 与单纯最佳药物治疗相比，超“时间窗”血管内治疗联合最佳药物治疗的急性大血管闭塞患者发病后12个月神经功能预后更佳。

关键词: 缺血性卒中, 动脉闭塞性疾病, 血栓切除术, 预后, Logistic模型, Kaplan-Meiers评估

Abstract:

Objective: To evaluate the long-term prognosis in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window (> 24 h) who received endovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated with BMT alone. Methods: This study included 158 patients from a prospective cohort of acute ischemic stroke due to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July 2023.The 158 patients with anterior circulation large vessel occlusion were divided into received EVT combined with BMT (EVT group, n=70) and received BMT alone (BMT group, n=88).Long-term neurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset.Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factors of long-term neurological prognosis.Sensitivity analyses were performed using propensity score matching (PSM) and multiple imputation (MI). Results: Logistic regression analysis showed that EVT was a protective factor for good long-term neurological prognosis (mRS score ≤ 2; OR=3.110, 95%CI: 1.460-6.620, P=0.003), increasing age (OR=0.955, 95%CI: 0.924-0.987; P=0.007) and hypertension (OR=0.418, 95%CI: 0.187-0.936; P=0.034) were risk factors.In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long-term neurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR=3.610, 95%CI: 1.370-9.550, P=0.010; MI: aOR=3.870, 95%CI: 1.780-8.440, P=0.000).The results were consistent with the main analysis. Conclusions: Compared to BMT group, EVT group patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window was demonstrated a significantly better long-term neurological prognosis.

Key words: Ischemic stroke, Arterial occlusive diseases, Thrombectomy, Prognosis, Logistic models, Kaplan-Meier estimate