Factors related to efficacy of endovascular therapy for patients with
acute ischemic stroke

doi:10.3760/cma.j.issn.1007-1245.2022.21.003

Abstract

Abstract: With the publication of five randomized controlled clinical trials in 2015, endovascular therapy has become the preferred treatment for patients with acute cerebral infarction caused by large artery occlusion. Some patients have poor prognosis despite recanalization. By consulting relevant data, the author found that there were many factors that may affect the effect and prognosis of recanalization. This article reviews the possible factors affecting the efficacy of endovascular therapy, including time window, hyperglycemia, collateral circulation, blood pressure, number of thrombectomy, and National Institutes of Health Stroke Scale (NIHSS) score.

Key words: Acute ischemic stroke, Endovascular therapy, Curative effect, Related factors

摘要： 随着2015年5项随机对照临床试验陆续发表，血管内治疗已成为大动脉闭塞所致急性脑梗死患者优选治疗方案。有一部分患者尽管血管已经再通，但是其预后不良。笔者通过查阅相关资料，发现有很多因素可能会影响到血管再通的效果及预后。该文就从时间窗、高血糖、侧支循环、血压、取栓次数、美国国立卫生研究院卒中量表（NIHSS）评分等部分影响血管内治疗疗效的可能因素作一综述。

关键词: 急性缺血性卒中, 血管内治疗, 疗效, 相关因素

Li Mingyue, Li Ziru, Yao Yuan, Yuan Jun. Factors related to efficacy of endovascular therapy for patients with acute ischemic stroke[J]. International Medicine and Health Guidance News, 2022, 28(21): 2969-2973.

李明月李自如姚远袁军. 急性缺血性卒中患者血管内治疗疗效的相关因素分析[J]. 国际医药卫生导报, 2022, 28(21): 2969-2973.

References

[1] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.DOI:10.3760/cma.j.issn.1006-7876.2015.04.002.
[2] Zhao D, Liu J, Wang W, et al. Epidemiological transition of stroke in China: twenty-one-year observational study from the Sino-MONICA-Beijing Project[J]. Stroke, 2008,39(6):1668-1674. DOI: 10.1161/STROKEAHA.107.502807.
[3] Xu AD, Wang YJ, Wang DZ, et al. Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese Stroke Therapy Expert Panel[J]. CNS Neurosci Ther, 2013,19(8):543-548. DOI: 10.1111/cns.12126.
[4] Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013,44(3):870-947. DOI: 10.1161/STR.0b013e318284056a.
[5] Levy EI, Siddiqui AH, Crumlish A, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke)[J]. Stroke, 2009,40(11):3552-3556. DOI: 10.1161/STROKEAHA.109.561274.
[6] Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials[J]. Lancet, 2014,384(9958):1929-1935. DOI: 10.1016/S0140-6736(14)60584-5.
[7] Asadi H, Dowling R, Yan B, et al. Advances in endovascular treatment of acute ischaemic stroke[J]. Intern Med J, 2015,45(8):798-805. DOI: 10.1111/imj.12652.
[8] 周峰,施洪超,陆敏,等.静脉溶栓在急性前循环大血管闭塞性脑卒中血管内治疗中的作用[J].中华神经科杂志,2019,52(6):472-477.DOI:10.3760/cma.j.issn.1006-7876.2019.06.006.
[9] Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J]. Lancet, 2016,387(10029):1723-1731. DOI: 10.1016/S0140-6736(16)00163-X.
[10] Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. N Engl J Med, 2015,372(24):2285-2295. DOI: 10.1056/NEJMoa1415061.
[11] Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med, 2015,372(11):1009-1018. DOI: 10.1056/NEJMoa1414792.
[12] Berkhemer OA, Fransen PS, Beumer D, et al. Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi: 10.1056/NEJMoa1411587.
[13] Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med, 2015,372(24):2296-2306. DOI: 10.1056/NEJMoa1503780.
[14] Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med, 2015,372(11):1019-1030. DOI: 10.1056/NEJMoa1414905.
[15] Albers GW, Lansberg MG, Brown S, et al. Assessment of optimal patient selection for endovascular thrombectomy beyond 6 hours after symptom onset: a pooled analysis of the AURORA database[J]. JAMA Neurol, 2021,78(9):1064-1071. DOI: 10.1001/jamaneurol.2021.2319.
[16] Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants[J]. Lancet, 2011,378(9785):31-40. DOI: 10.1016/S0140-6736(11)60679-X.
[17] Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030[J]. Diabetes Care, 2004,27(5):1047-1053. DOI: 10.2337/diacare.27.5.1047.
[18] Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030[J]. Diabetes Res Clin Pract, 2010,87(1):4-14. DOI: 10.1016/j.diabres.2009.10.007.
[19] Putaala J, Liebkind R, Gordin D, et al. Diabetes mellitus and ischemic stroke in the young: clinical features and long-term prognosis[J]. Neurology, 2011,76(21):1831-1837. DOI: 10.1212/WNL.0b013e31821cccc2.
[20] Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview[J]. Stroke, 2001,32(10):2426-2432. DOI: 10.1161/hs1001.096194.
[21] Zi W, Wang H, Yang D, et al. Clinical effectiveness and safety outcomes of endovascular treatment for acute anterior circulation ischemic stroke in China[J]. Cerebrovasc Dis, 2017,44(5-6):248-258. DOI: 10.1159/000478667.
[22] Anderson RE, Tan WK, Martin HS, et al. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra[J]. Stroke, 1999,30(1):160-170. DOI: 10.1161/01.str.30.1.160.
[23] Li PA, Shuaib A, Miyashita H, et al. Hyperglycemia enhances extracellular glutamate accumulation in rats subjected to forebrain ischemia[J]. Stroke, 2000,31(1):183-192. DOI: 10.1161/01.str.31.1.183.
[24] Kamada H, Yu F, Nito C, et al. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction[J]. Stroke, 2007,38(3):1044-1049. DOI: 10.1161/01.STR.0000258041.75739.cb.
[25] Cannarsa GJ, Wessell AP, Chryssikos T, et al. Initial stress hyperglycemia is associated with malignant cerebral edema, hemorrhage, and poor functional outcome after mechanical thrombectomy[J]. Neurosurgery, 2022,90(1):66-71. DOI: 10.1227/NEU.0000000000001735.
[26] Mishiro K, Imai T, Sugitani S, et al. Diabetes mellitus aggravates hemorrhagic transformation after ischemic stroke via mitochondrial defects leading to endothelial apoptosis[J]. PLoS One, 2014,9(8):e103818. DOI: 10.1371/journal.pone.0103818.
[27] 皮成慧,王君,张荣举,等.颅内侧支循环对急性脑梗死患者预后影响的研究进展[J].中国脑血管病杂志,2018,15(4):212-215.DOI:10.3969/j.issn.1672-5921.2018.04.009.
[28] Bang OY, Saver JL, Kim SJ, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke[J]. Stroke, 2011,42(3):693-699. DOI: 10.1161/STROKEAHA.110.595256.
[29] Xu Y, Guo S, Jiang H, et al. Collateral status and clinical outcomes after mechanical thrombectomy in patients with anterior circulation occlusion[J]. J Healthc Eng, 2022,2022:7796700. DOI: 10.1155/2022/7796700.
[30] John S, Hazaa W, Uchino K, et al. Timeline of blood pressure changes after intra-arterial therapy for acute ischemic stroke based on recanalization status[J]. J Neurointerv Surg, 2017,9(5):455-458. DOI: 10.1136/neurintsurg-2016-012369.
[31] Matusevicius M, Cooray C, Bottai M, et al. Blood pressure after endo-vascular thrombectomy: modeling for outcomes based on recanalization status[J]. Stroke, 2020,51:519-525. DOI: 10.1161/STROKEAHA.119.026914.
[32] Venema E, Mulder MJHL, Roozenbeek B, et al. Selection of patients for intra-arterial treatment for acute ischaemic stroke: development and validation of a clinical decision tool in two randomised trials[J]. BMJ, 2017,357:j1710. DOI: 10.1136/bmj.j1710.
[33] Mulder MJHL, Ergezen S, Lingsma HF, et al. Baseline blood pressure effect on the benefit and safety of intra-arterial treatment in MR CLEAN (multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands)[J]. Stroke, 2017,48(7):1869-1876. DOI: 10.1161/STROKEAHA.116.016225.
[34] van den Berg SA, Uniken Venema SM, Mulder MJHL, et al. Admission blood pressure in relation to clinical outcomes and successful reperfusion after endovascular stroke treatment[J]. Stroke, 2020,51(11):3205-3214. DOI: 10.1161/STROKEAHA.120.029907.
[35] Ding X, Xu C, Zhong W, et al. Association of maximal systolic blood pressure with poor outcome in patients with hyperattenuated lesions on immediate NCCT after mechanical thrombectomy[J]. J Neurointerv Surg, 2020,12(2):127-131. DOI: 10.1136/neurintsurg-2019-014846.
[36] Oliveira-Filho J, Silva SC, Trabuco CC, et al. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset[J]. Neurology, 2003,61(8):1047-1051. DOI: 10.1212/01.wnl.0000092498.75010.57.
[37] Mistry EA, Mistry AM, Nakawah MO, et al. Systolic Blood Pressure Within 24 Hours After Thrombectomy for Acute Ischemic Stroke Correlates With Outcome[J]. J Am Heart Assoc, 2017,6(5):e006167. DOI: 10.1161/JAHA. 117.006167.
[38] Samuels N, van de Graaf RA, van den Berg CAL, et al. Blood pressure in the first 6 hours following endovascular treatment for ischemic stroke is associated with outcome[J]. Stroke, 2021,52(11):3514-3522. DOI: 10.1161/STROKEAHA.120.033657.
[39] Hao Y, Yang D, Wang H, et al. Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke[J]. Stroke, 2017,48(5):1203-1209. DOI: 10.1161/STROKEAHA.116.016368.
[40] García-Tornel Á, Requena M, Rubiera M, et al. When to Stop[J]. Stroke, 2019,50(7):1781-1788. DOI: 10.1161/STROKEAHA.119.025088.
[41] Linfante I, Starosciak AK, Walker GR, et al. Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry[J]. J Neurointerv Surg, 2016,8(3):224-229. DOI: 10.1136/neurintsurg- 2014-011525.
[42] 栗艳茹,韩冰莎,赵敬河,等.电磁扰动系数对急性缺血性卒中机械开通术后出血转化的预测作用[J].中国脑血管病杂志,2020,17(1):6-10,25.DOI:10.3969/j.issn.1672- 5921.2020.01.003.
[43] 张兵军,石乃华,时小利,等.急性缺血性脑卒中取栓术后发生颅内出血性转化的危险因素[J].心脑血管病防治,2019,19(5):429-431.DOI:10.3969/j.issn.1009- 816x. 2019.05.013.
[44] Ge WQ, Chen J, Pan H, et al. Analysis of risk factors increased hemorrhagic transformation after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2018,27(12):3587-3590. DOI: 10.1016/j.jstrokecerebrovasdis. 2018.08.028.
[45] Zhu F, Labreuche J, Haussen DC, et al. Hemorrhagic Transformation After Thrombectomy for Tandem Occlusions[J]. Stroke, 2019,50(2):516-519. DOI: 10.1161/STROKEAHA.118.023689.
[46] Hendrix P, Melamed I, Collins M, et al. NIHSS 24 h after mechanical thrombectomy predicts 90-day functional outcome[J]. Clin Neuroradiol, 2022,32(2):401-406. DOI: 10.1007/s00062-021-01068-4.
[47] Shi ZS, Liebeskind DS, Xiang B, et al. Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes[J]. Stroke, 2014,45(7):1977-1984. DOI: 10.1161/STROKEAHA. 114.005603.
[48] Liu R, Li W, Li Y, et al. Total time of operation is a risk factor of stroke-associated pneumonia in acute ischemic stroke patients with intra-arterial treatment[J]. Medicine (Baltimore), 2016,95(29):e3958. DOI: 10.1097/MD.0000000000003958.
[49] Khatri P, Wechsler LR, Broderick JP. Intracranial hemorrhage associated with revascularization therapies[J]. Stroke, 2007,38(2):431-40. DOI: 10.1161/01.STR.0000254524.23708.c9.
[50] Linfante I, Walker GR, Castonguay AC, et al. Predictors of mortality in acute ischemic stroke intervention: analysis of the North American Solitaire Acute Stroke Registry[J]. Stroke, 2015,46(8):2305-2308. DOI: 10.1161/STROKEAHA. 115.009530.
[51] 李艳,孙璐,李林娇,等.老年脑卒中照顾者的照顾能力与照顾负担的相关性研究[J].国际医药卫生导报,2020,26(18):2677-2680.DOI:10.3760/cma.j.issn.1007-1245.2020. 18.004.

Factors related to efficacy of endovascular therapy for patients with acute ischemic stroke

急性缺血性卒中患者血管内治疗疗效的相关因素分析

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 9

Recommended Articles

Metrics

[1]	Zhang Wenjun, Li Yueming, He Shiqi, Liang Shuhong, Liu Yingxue, Wu Yiling, Gong Yeqing. Effect of semiconductor laser combined with 30% supramolecular salicylic acid in treatment of acne curative and nursing experience [J]. International Medicine and Health Guidance News, 2022, 28(7): 1013-1016.
[2]	Wu Jie, Deng Xiuhong, Lei Lifang, Zhou Jiajia. Curative effect observation of comprehensive moxibustion therapy with Huolong Cupping in patients with cervical spondylosis and cervical pain [J]. International Medicine and Health Guidance News, 2022, 28(20): 2947-2950.
[3]	Liu Yu, Li Huijin, Song Qilin, Ye Cong, Zhu Qunfang. Analysis of the related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures in the young and middle-aged with "L"-shaped incision [J]. International Medicine and Health Guidance News, 2022, 28(2): 166-170.
[4]	Pan Chunliu, Huang Zhihua. Meta-analysis of patient-related factors of medical adhesive related skin injury in ICU [J]. International Medicine and Health Guidance News, 2022, 28(2): 270-277.
[5]	Yu Chaosheng, Yu Feng, Deng Haiyan, Li Junzheng, Huang Changjin, Li Hui. Clinical efficacy of electroacupuncture and acupoint injection in the treatment of sudden deafness [J]. International Medicine and Health Guidance News, 2022, 28(18): 2522-2527.
[6]	Zhao Liuyan, Song Shoujun, Xue Haibo. Effectiveness and safety of molecular targeted drugs in treatment of refractory thyroid cancer: a meta-analysis [J]. International Medicine and Health Guidance News, 2022, 28(17): 2369-2376.
[7]	Qi Youtao, Wang Dongmei, Bai Yuhuan, Kong Lingjia, Jing Changchun, Ji Bei. Apatinib combined with tegafur in treatment of patients with advanced gastric cancer and its influence on prognosis [J]. International Medicine and Health Guidance News, 2022, 28(13): 1815-1819.
[8]	Xu Zhenbin, Yang Xiaoxiong, Zhuang Yanyun, Xi Yanjun, Chen Peng, Wu Qi, Yuan Meirong, Ji Chulian. Observation on the effect of H-uvulopalatopharyngoplasty for OSAHS patients [J]. International Medicine and Health Guidance News, 2022, 28(12): 1656-1660.
[9]	Li Hongjun. Clinical effect and safety of pulmonary surfactant combined with NCPAP in the treatment of NRDS in different periods [J]. International Medicine and Health Guidance News, 2022, 28(10): 1414-1417.