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 Neurology:大面积急性缺血性卒中患者血管内取栓术与功能预后的关系

2022-09-01 Naomi MedSci原创

近日,一项发表在Neurology上的研究发现,在基线CTP缺血核心容量为70-100毫升的患者中,EVT与卒中后3个月的预后呈正相关,而在≥100毫升的患者中则不然。需要随机数据来证实这些发现。

血管血栓切除术(EVT)对CT灌注(CTP)确定的缺血核心体积较小的大血管闭塞(LVO)卒中患者是有效的。然而,对于核心容量>70ml的患者,EVT的益处尚不清楚。近日,一项发表在Neurology上的研究比较了核心≥70ml的EVT和非EVT患者的预后,假设卒中后三个月的改良朗肯分级(MRS,0-3)对EVT患者的预后有好处。

研究人员回顾分析在多中心(澳大利亚、中国和加拿大)登记的患者(2012年至2020年),这些患者在卒中发病24小时内接受了CTP,且基线缺血核心≥70ml。主要结果是对核心容量≥70ml的患者以及70-100ml和≥100ml亚组患者的EVT与预后良好的相关性进行评估。

 

  • 在登记的3283例患者中,299例核心≥70ml,269例数据完整(135例核心容量在70-100ml~134≥100ml之间)。
  • 121例(45%)患者行EVT。接受EVT治疗的患者更年轻(中位数69岁对75岁;p=0.011),卒中前MRS较低,核心体积中位数较小,92[79-116.5]毫升对105.5[85.75138]毫升(p=0.004)。
  • 在调整后的分析中,接受EVT治疗的患者获得良好结果的几率更高(非EVT组为30%比13.9%;AOR2.1(95%CI 1,4.2),p=0.038)。
  • 受益主要见于70-100ml核心的患者(71/135(52.6%)接受EVT治疗),其中接受EVT治疗的54.3%与非EVT组的21%取得了良好的结果(AOR2.5(95%可信区间1,6.2),p=0.005)。
  • 在核心缺血体积≥100ml的患者中,50例(37.3%)接受了EVT。
  • 两组患者的公平结局比例都非常低(8.1%对8.7%;p=0.908)。

研究发现,在基线CTP缺血核心容量为70-100毫升的患者中,EVT与卒中后3个月的预后呈正相关,而在≥100毫升的患者中则不然。需要随机数据来证实这些发现。

证据分类这项研究提供了III类证据,证明在核心为70-100毫升的CTP定义的缺血性卒中后3个月,EVT与更好的运动结果有关。

文献来源:Garcia-Esperon C, Bivard A, Johns H, et al. Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core [published online ahead of print, 2022 Jul 8]. Neurology. 2022;10.1212/WNL.0000000000200908. doi:10.1212/WNL.0000000000200908

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createdBy=66ec123, createdName=guihongzh, createdTime=Wed Jun 28 22:54:14 CST 2023, time=2023-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1954527, encodeId=c614195452ebb, content=<a href='/topic/show?id=7a804404823' target=_blank style='color:#2F92EE;'>#大面积#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44048, encryptionId=7a804404823, topicName=大面积)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Fri Sep 09 23:54:14 CST 2022, time=2022-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001928, encodeId=0f18200192827, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, 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objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79360, encryptionId=9cf7e9360d2, topicName=缺血性卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Nov 10 05:54:14 CST 2022, time=2022-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2033454, encodeId=0147203345407, content=<a href='/topic/show?id=800638008ea' target=_blank style='color:#2F92EE;'>#取栓术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38008, encryptionId=800638008ea, topicName=取栓术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Mon Dec 26 02:54:14 CST 2022, time=2022-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479130, encodeId=eb8214e913083, content=<a href='/topic/show?id=b97f3800ee0' target=_blank style='color:#2F92EE;'>#取栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38007, encryptionId=b97f3800ee0, topicName=取栓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99077483919, createdName=1249862am74(暂无昵称), createdTime=Thu Sep 01 11:54:14 CST 2022, time=2022-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492873, encodeId=2d1814928e346, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Sep 01 11:54:14 CST 2022, time=2022-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1242445, encodeId=f1801242445dc, content=谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76198244166, createdName=ms6000001111231424, createdTime=Thu Sep 01 10:54:58 CST 2022, time=2022-09-01, status=1, ipAttribution=)]
    2023-01-27 yinhl1978
  5. [GetPortalCommentsPageByObjectIdResponse(id=1806544, encodeId=b60118065446a, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Nov 01 11:54:14 CST 2022, time=2022-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893549, encodeId=18a1189354933, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, 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time=2022-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1242445, encodeId=f1801242445dc, content=谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76198244166, createdName=ms6000001111231424, createdTime=Thu Sep 01 10:54:58 CST 2022, time=2022-09-01, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1806544, encodeId=b60118065446a, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Tue Nov 01 11:54:14 CST 2022, time=2022-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893549, encodeId=18a1189354933, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, 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  7. 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    2022-09-01 ms6000001111231424

    谢谢

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在接受血栓摘除术的缺血性卒中儿童中,良好的侧支与改善放射学结果有关,但与更好的临床结果无关。

Neurology:优化急性缺血性卒中的血管内血栓摘除术的早期血压管理可改善患者预后

血管内血栓摘除术后24小时内平均收缩压水平升高与症状性颅内出血、早期神经恶化、3个月死亡率和3个月功能预后较差的几率增加独立相关。

Neurology:改良 rankin 量表与脑卒中后上肢无力患者恢复表型的关系

精确评估预后对于卒中试验和临床护理至关重要; 研究证实mRS大致与特定领域的预后有关,但没有准确区分损害和功能差异,也没有充分捕捉跨损害的有意义的临床变化、ADL状态和机动性,具体表型具体应用格外重要

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ISC 2024:甲基强的松龙辅助血管内血栓切除术治疗大血管闭塞性卒中

在大血管闭塞所致急性缺血性卒中患者行血管内手术血栓切除术治疗中,甲基强的松龙辅助血管内手术血栓切除术治疗并没有显著改善整体残疾程度。

J AM COLL RADIOL:有关老年人缺血性卒中医院费用增常的驱动因素

最近的一项研究显示,指南修改后,IS患者的EVT使用率立即大幅提高(从2015年的2.9%的病例提高到2019年的7.9%的病例)。然而,与这一治疗转变相关的成本还没有被进一步评估。

Neurology:疑似大血管闭塞患者直接转至血管造影室的成本-效果分析 

对于疑似大血管闭塞脑卒中患者,ITER 上直接转移到血管造影室(DTAS)策略的成本效益是稳健的。结合最近发表的临床结果,这意味着可以考虑实施 DTAS 策略来改善 EVT 的工作流程和结果。

Neurology:轻度脑卒中合并大血管闭塞患者血流灌注变量与功能预后的关系 

在缺血性卒中和大血管闭塞(LVO)患者中,血管内血栓切除术(EVT)已成为发病后24小时内的标准护理。研究发现,灌注损伤≥65mL 预示轻度脑卒中伴大血管闭塞患者功能预后不良。

Neurology:全身麻醉与非全身麻醉下血栓切除术的结果:来自Extended-IA试验和选择研究的患者水平的综合分析 

血管内血栓切除术(EVT)改善了前循环近端大血管闭塞(LVO)缺血性卒中患者的临床预后。研究提供了 III 类证据表明,使用全身麻醉与血管内血栓切除术患者功能结果较差有关。

Neurology:急性卒中合并癌症患者血管内血栓取出术的疗效观察

癌症是急性缺血性卒中(AIS)患者的常见共病。将血管内血栓切除术(EVT)确立为大血管闭塞治疗标准的随机对照试验一般排除癌症患者。因此,血管内血栓摘除术在癌症人群中的临床益处目前尚不清楚。

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