浙江大学学报（医学版）2026，Vol.55Issue(2)：113-120,8.DOI:10.3724/zdxbyxb-2025-0556
合并大血管闭塞急性缺血性脑卒中患者超过24至72h机械取栓的有效性及安全性
Efficacy and safety of mechanical thrombectomy beyond 24 to 72 hours in acute ischemic stroke patients with large vessel occlusion
摘要
Abstract
Objective:To evaluate the efficacy and safety of mechanical thrombectomy performed beyond 24 hours from symptom onset in patients with acute ischemic stroke(AIS)and large vessel occlusion(LVO).Methods:In this retrospective cohort study,patients with LVO-related AIS who underwent mechanical thrombectomy within 72 hours of onset were enrolled from the Acute Stroke Patients for Stroke Management Quality Evaluation online database(CASE-Ⅱ,NCT04487340)between January 2017 and December 2024.Patients were stratified into beyond 24-hour thrombectomy group and within 24-hour thrombectomy group based on the time from onset to mechanical thrombectomy.Propensity score matching(PSM)was used to balance baseline characteristics between the two groups.Binary logistic regression and generalized linear models were employed to compare 3-month functional and safety outcomes between the groups.Sensitivity analyses were conducted separately in patients undergoing mechanical thrombectomy within the extended time window(6-24 hours)and in those receiving mechanical thrombectomy alone(without prior intravenous thrombolysis).Subgroup analyses were performed based on age,presence of atrial fibrillation,use of oral anticoagulants,pre-stroke modified Rankin Scale(mRS)score,baseline National Institutes of Health Stroke Scale(NIHSS)score,and occlusion site.Results:Of the 9121 patients included,277 underwent mechanical thrombectomy beyond 24 hours and 8844 within 24 hours.After PSM,534 patients were analyzed(267 per group).No significant difference was found in the rate of 3-month functional independence(mRS score 0-2)between the beyond 24-hour and within 24-hour thrombectomy groups,both before and after matching(OR=0.977,95%CI:0.753-1.268,P=0.861;OR=1.151,95%CI:0.712-1.549,P=0.804,respectively).The rates of 24-hour symptomatic intracranial hemorrhage,24-hour parenchymal hemorrhage,and 3-month all-cause mortality also showed no significant differences between the two groups(all P>0.05).Sensitivity analyses among patients in the extended time window(6-24 hours)and those receiving mechanical thrombectomy alone yielded similar results,with no significant differences in functional or safety outcomes(all P>0.05).Subgroup analyses revealed no significant heterogeneity in the 3-month functional independence across various baseline characteristics(all P>0.05).Conclusion:For AIS patients with LVO,the efficacy and safety of mechanical thrombectomy performed beyond 24 hours appear comparable to those of mechanical thrombectomy performed within 24 hours.关键词
急性缺血性脑卒中/大血管闭塞/机械取栓/超时间窗/临床结局/安全性/回顾性研究Key words
Acute ischemic stroke/Large vessel occlusion/Mechanical thrombectomy/Extended time window/Clinical outcome/Safety/Retrospective study分类
医药卫生引用本文复制引用
江选飞,陈逸,金海娣,霍鑫龙,林青,王恩,涂汉明,楼敏,张冰..合并大血管闭塞急性缺血性脑卒中患者超过24至72h机械取栓的有效性及安全性[J].浙江大学学报（医学版）,2026,55(2):113-120,8.基金项目
国家自然科学基金(82171276,U23A20426) （82171276,U23A20426）
国家卫生健康委医药卫生科技发展研究中心脑卒中防治技术研究项目(WKZX2023CZ0220) （WKZX2023CZ0220）
浙江省自然科学基金(LTGY24H090004) （LTGY24H090004）
浙江省医药卫生科技计划(2023XY068) （2023XY068）
湖州市公益性技术应用研究(2018GYB07)This study was supported by National Natural Science Foundation of China (82171276,U23A20426),Research Project on Prevention and Treatment Techniques for Stroke of the Development Center for Medical Science & Technology,National Health Commission of the People's Republic of China (WKZX2023CZ0220),Zhejiang Provincial National Natural Science Foundation of China (LTGY24H090004),Medical and Health Science and Technology Project of Zhejiang Province (2023XY068),and Public Welfare Technology Application Research of Huzhou (2018GYB07) （2018GYB07）
