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Journal of The Korean Society of Emergency Medicine 2026;37(1): 39-46. |
| BEST Protocol 체계 하에서 재관류 치료 전략에 따른 급성 허혈성 뇌경색 환자의 임상 예후: 단일 센터 후향적 코호트 연구 |
주상현
, 김선표
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| 조선대학교병원 응급의학과 |
| Impact of reperfusion strategies on clinical outcomes in acute ischemic stroke managed under the standardized “BEST Protocol”: a single-center retrospective cohort study |
| Sang Hyun Joo
, Sun Pyo Kim
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| Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea |
| Correspondence |
Sun Pyo Kim ,Tel: 062-220-3285, Fax: 062-224-3501, Email: ksp93133@naver.com,
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Received: November 5, 2025; Revised: November 28, 2025 Accepted: December 9, 2025. Published online: February 28, 2026. |
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| ABSTRACT |
Objective:
This study evaluated the clinical outcomes of patients with acute ischemic stroke (AIS) based on different reperfusion strategies-intravenous thrombolysis (IVT) alone, mechanical thrombectomy (MT) alone, combined IVT+MT, or non-reperfusion therapy (non-RT)-managed under a standardized “Brain Salvage through Emergent Stroke Therapy (BEST) Protocol” in a single emergency center.
Methods:
This study conducted a single-center, retrospective cohort study of 261 AIS patients diagnosed under the BEST Protocol between March 2022 and February 2023. The patients were classified into four groups: IVT alone (n=38), MT alone (n=34), IVT+MT (n=30), and non-RT (n=159). The primary outcome was a favorable functional outcome (modified Rankin Scale≤2) at 90 days. Multivariable logistic regression was performed to determine the independent association of treatment strategies, adjusting for age, initial National Institutes of Health Stroke Scale score, and atrial fibrillation (AF).
Results:
The baseline characteristics showed significant differences in initial NIHSS, large vessel occlusion (LVO), and AF (P<0.001). After excluding LVO from the final model for parsimony, multivariable analysis revealed that, compared to the non-RT group, the MT alone group (adjusted odds ratio [aOR], 3.58; 95% confidence interval [CI], 1.23-10.42; P=0.019) and the IVT+MT group (aOR, 5.75; 95% CI, 1.75-18.92; P=0.004) were strongly associated with a favorable 90-day outcome after adjusting for covariates.
Conclusion:
In a standardized system like the BEST Protocol, MT-based strategies (MT alone or IVT+MT) were independently associated with a significantly higher likelihood of favorable 90-day functional outcomes compared to non-RT. |
| Key words:
Stroke; Tissue plasminogen activator; Thrombectomy |
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