近日，瑞士伯尔尼大学医院Urs Fischer团队研究了血管内治疗中远端血管闭塞性卒中的疗效与安全性。2025年2月5日出版的《新英格兰医学杂志》发表了这项成果。

众所周知，大血管闭塞性卒中的血管内治疗（EVT）安全有效。EVT对闭塞中远端血管的效果尚不清楚。

研究组随机分配了患有孤立性中远端血管闭塞的参与者（大脑中动脉[MCA]的非显性或共显性M2段；大脑中动脉的M3或M4段；大脑前动脉的A1、A2或A3段；或大脑后动脉的P1、P2或P3段闭塞），在参与者最后一次被视为健康后24小时内接受EVT加最佳药物治疗或单独接受最佳药物治疗。主要结局是90天时的残疾程度，用改良Rankin量表评分进行评估。

共有543名参与者（女性，44%；中位年龄，77岁）被纳入分析：271人被分配接受EVT加最佳治疗，272人仅接受最佳治疗。入院时，美国国立卫生研究院卒中量表的中位得分（范围为0至42，得分越高表示症状越严重）为6（四分位数间距为5至9）。65.4%的参与者接受了静脉溶栓治疗。主要的闭塞位置是M2段（44.0%的参与者）、M3段（26.9%）、P2段（13.4%）和P1段（5.5%）。

在EVT加最佳药物治疗和单独使用最佳药物治疗之间的比较中，在90天时，改良Rankin量表评分的分布没有显著差异（评分改善的常见比值比为0.90；95%置信区间为0.67至1.22；P=0.50）。两组的全因死亡率相似（EVT加最佳药物治疗组为15.5%，单独使用最佳药物组为14.0%），症状性颅内出血的发生率也相似（分别为5.9%和2.6%）。

研究结果表明，与单独使用最佳药物治疗相比，在中风患者中远端血管闭塞的情况下，EVT不会导致较低的残疾率或较低的死亡率。

附：英文原文

Title: Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels

Author: Marios Psychogios, Alex Brehm, Marc Ribo, Federica Rizzo, Daniel Strbian, Silja Rty, Juan F. Arenillas, Mario Martínez-Galdámez, Steven D. Hajdu, Patrik Michel, Jan Gralla, Eike I. Piechowiak, Daniel P.O. Kaiser, Volker Puetz, Frans Van den Bergh, Sylvie De Raedt, Flavio Bellante, Anne Dusart, Victoria Hellstern, Ali Khanafer, Guillermo Parrilla, Ana Morales, Jan S. Kirschke, Silke Wunderlich, Jens Fiehler, Gtz Thomalla, Robin Lemmens, Jo P. Peluso, Manuel Bolognese, Alexander von Hessling, Adriaan van Es, Nyika D. Kruyt, Jonathan M. Coutinho, Carlos Castao, Jens Minnerup, Wim van Zwam, Elisabeth Dhondt, Christian H. Nolte, Paolo Machi, Christian Loehr, Heinrich P. Mattle, Jan-Hendrik Buhk, Johannes Kaesmacher, Tomas Dobrocky, Panagiotis Papanagiotou, Angelika Alonso, Markus Holtmannspoetter, Andrea Zini, Leonardo Renieri, Fee Keil, Ido van den Wijngaard, Georg Kgi, Mikel Terceo, Martin Wiesmann, Sergio Amaro, Nikki Rommers, Luzia Balmer, Isabel Fragata, Mira Katan, Ronen R. Leker, Jeffrey L. Saver, Julie Staals, Urs Fischer

Issue&Volume: 2025-02-05

Abstract:

BACKGROUND

Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear.

METHODS

We randomly assigned participants with an isolated occlusion of medium or distal vessels (occlusion of the nondominant or codominant M2 segment of the middle cerebral artery [MCA]; the M3 or M4 segment of the MCA; the A1, A2, or A3 segment of the anterior cerebral artery; or the P1, P2, or P3 segment of the posterior cerebral artery) to receive EVT plus best medical treatment or best medical treatment alone within 24 hours after the participant was last seen to be well. The primary outcome was the level of disability at 90 days, as assessed with the modified Rankin scale score.

RESULTS

A total of 543 participants (women, 44%; median age, 77 years) were included in the analysis: 271 were assigned to receive EVT plus best medical treatment and 272 to receive best medical treatment alone. The median score on the National Institutes of Health Stroke Scale (range, 0 to 42, with higher scores indicating more severe symptoms) at admission was 6 (interquartile range, 5 to 9). Intravenous thrombolysis was given to 65.4% of the participants. The predominant occlusion locations were the M2 segment (in 44.0% of the participants), M3 segment (in 26.9%), P2 segment (in 13.4%), and P1 segment (in 5.5%). In the comparison between EVT plus best medical treatment and best medical treatment alone, no significant difference in the distribution of modified Rankin scale scores was observed at 90 days (common odds ratio for improvement in the score, 0.90; 95% confidence interval, 0.67 to 1.22; P=0.50). All-cause mortality was similar in the two groups (15.5% with EVT plus best medical treatment and 14.0% with best medical treatment alone), as was the incidence of symptomatic intracranial hemorrhage (5.9% and 2.6%, respectively).

CONCLUSIONS

In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone.

DOI: NJ202502050000001

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2408954