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Stroke:急性缺血性卒中患者成功机械血栓切除术后意外早期再闭塞的预测因素

2018-09-18 xing.T MedSci原创

由此可见,成功进行机械血栓切除术后48小时内早期再闭塞很少见,但结局不佳有关。入院时血小板较高、血栓切除部位残留栓塞碎片或狭窄的患者再次闭塞的风险很高,在仔细重新评估过去的血管造影术后可以预防或纠正这些风险。

持续成功再灌注是急性缺血性卒中良好临床结局的重要预后因素。近日,卒中领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在通过一个前瞻性队列来明确最初成功的血栓切除术后早期再闭塞的患病率、临床影响和预测因素。

该研究共纳入了711例脑卒中患者,这些患者在成功再灌注(脑梗塞改良溶栓为2b/3)后24-48小时进行了磁共振或计算机断层扫描血管造影。多变量logistic回归分析用于评估相关因素和临床影响。结果展示为调整后的比值比(aOR)和95%可信区间。研究人员通过曲线下面积评估了干预后血管造影控制的额外成像结果准确性的改善情况。

711例成功再灌注患者中有16例患者观察到早期再闭塞(2.3%; 95%CI为1.1-3.3;中位延迟为20小时)。提示性预测因素是入院时血小板较高(aOR为1.01; 95%CI为1.01-1.02)、卒中前功能依赖(aOR为7.12; 95%CI为1.49-34.03)以及TOAST分类中未确定或其它特定发病机制的卒中(分别有aOR为7.19; 95%CI为1.10-47.05和aOR为36.50; 95%CI为4.47-298.11)。当将血栓切除部位残余栓塞碎片或狭窄纳入Logistic回归模型时,存在和不存在再闭塞的患者之间的区别显著改善(曲线下面积为0.955 vs. 0.854; P=0.023)。早期再闭塞是90天时不良结局的独立预测因子(改良Rankin量表≤2的aOR为0.13; 95%CI为0.03-0.57)。

由此可见,成功进行机械血栓切除术后48小时内早期再闭塞很少见,但结局不佳有关。入院时血小板较高、血栓切除部位残留栓塞碎片或狭窄的患者再次闭塞的风险很高,在仔细重新评估过去的血管造影术后可以预防或纠正这些风险。

原始出处:

Pascal J. Mosimann,et al. Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients.Stroke. 2018. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021685

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  4. 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  5. 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  6. 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  7. 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  8. 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  9. 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  10. 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style='color:#2F92EE;'>#机械血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61274, encryptionId=2502612e461, topicName=机械血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e4137, createdName=meichuangyi, createdTime=Tue Aug 27 22:19:00 CST 2019, time=2019-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264300, encodeId=c9c0126430082, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Thu Sep 20 11:19:00 CST 2018, time=2018-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1314267, encodeId=46aa131426e5e, content=<a href='/topic/show?id=585189089f4' target=_blank style='color:#2F92EE;'>#血栓切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89089, encryptionId=585189089f4, topicName=血栓切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=284b425, createdName=zll0625, createdTime=Thu Sep 20 11:19:00 CST 2018, time=2018-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401021, encodeId=1d3a14010217f, content=<a href='/topic/show?id=4a328909094' target=_blank style='color:#2F92EE;'>#血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89090, encryptionId=4a328909094, topicName=血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/iaZNoEMO3BP2wXbOyFTHLDM0NM4jtMZVRFjy61kQCBKjzhYeGClbvzoxiccabPRrcEaq76VWKCSNCQUqAxDnOd4w/132, createdBy=0a332291710, createdName=shuangle, createdTime=Thu Sep 20 11:19:00 CST 2018, time=2018-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026155, encodeId=c826102615516, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Tue Sep 18 23:19:00 CST 2018, time=2018-09-18, status=1, ipAttribution=)]
    2018-09-18 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

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