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Stroke:血栓切除术后多支血管闭塞患者的结局

2018-05-22 国际循环编辑部 国际循环

栓塞性大血管阻塞患者会出现与受累区域内或远处同时性急性闭塞,即为多支血管闭塞(MVO)。Stroke杂志发表的一项最新研究,评估进行血管内卒中治疗的患者MVO发病率、相关因素和临床相关性。

栓塞性大血管阻塞患者会出现与受累区域内或远处同时性急性闭塞,即为多支血管闭塞(MVO)。Stroke杂志发表的一项最新研究,评估进行血管内卒中治疗的患者MVO发病率、相关因素和临床相关性。

该研究从前瞻性登记中提取直接获得血管造影的连续血管内患者的图像数据(n=720)。MVO发病率通过多模式磁共振成像/计算机断层扫描评估,并通过动脉内血管造影证实。相关因素和临床相关性的探索性分析使用多因素logistic回归分析进行,包括单因素比较P<0.15的变量。良好功能结局定义为第90天改良Rankin量表评分≤2。

结果发现,10.7%的患者存在MVO(95%CI:6.4%~13.0%)。在MVO病例中发现有80.5%,16.9%和2.6%的患者伴发2、3、4处闭塞。初始放射学报告检出率为54.5%。与MVO相关的独立因素包括他汀类药物治疗(校正aOR=0.477;95%CI:0.276~0.827),收缩压较高(aOR每mm Hg增加1.014,95%CI:1.005~1.023),闭塞起始部位M2(aOR=1.870;95%CI:1.103~3.170)。MVO与再灌注成功率较低有关(aOR=0.549;95%CI:0.316~0.953),良好功能转归率较低(aOR=0.437;95%CI:0.207~0.923)。

该研究中,每10例接受血管造影术的MVO患者进行了血管内卒中治疗,并且在介入前诊断性影像中仅50%为前瞻性鉴定。MVO患者的基线收缩压较高,并且他汀类药物治疗的次数较少,这一观察结果还需开展其他试验以进一步验证和评估因果关系。MVO的发病率可影响治疗决策,对血管内治疗的成功率呈负面影响,并且预示着更差的临床结局。

原始出处:
Johannes Kaesmacher, Pascal J. Mosimann, Mattia Giarrusso, et al. Multivessel Occlusion in Patients Subjected to Thrombectomy. Stroke. May 2018.

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白细胞释放的抗菌肽有助于消除病原体和激活免疫系统,但是其在血栓形成中的作用尚未完全了解。在这里我们显示cathelicidin LL-37在急性心肌梗塞患者的血栓中的水平较高。其小鼠同系物CRAMP存在于血管损伤后的小鼠动脉血栓中,并且主要来源于循环中性粒细胞。骨髓嵌合体小鼠中造血CRAMP的缺乏减少了血小板募集和血栓形成。LL-37和CRAMP通过蛋白酪氨酸激酶Src/Syk和磷脂酶C参与糖蛋白

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