JAMA Neurol:血管内血栓切除术与大面积缺血性中风患者预后

2019-08-07 MedSci MedSci原创

研究发现,大面积缺血性中风患者接受EVT治疗可获得较好预后,但效果随中风体积和治疗时间的增加而显著下降

目前血管血栓切除术(EVT)对大面积缺血性患者的疗效和安全性尚不清楚,近日研究人员比较了EVT与单纯药物管理治疗大面积缺血核心患者的疗效差异。

研究于2016年1月至2018年2月在9个美国脑卒中综合治疗中心进行,并随访90天。中重度中风和前循环大血管闭塞患者参与,随机接受血管内血栓切除与药物治疗(MM),或者仅药物治疗。研究的主要终点为改良的Rankin评分90天的功能结果;安全性结果包括死亡率、症状性脑出血和神经恶化。

105例大的缺血性中风患者参与研究,年龄中位数为66岁,女性45例(43%)。接受EVT治疗的62例患者中,19例(31%)功能良好(改良Rankin评分,0-2),MM治疗仅6例(14%) (OR: 3.27)。与MM相比,EVT与更好的功能预后(OR:2.12),更少的梗死增加(44 vs 98 ml;P=0.006),更小的最终梗死体积(97 vs 190 ml)相关,但10例血栓容积大于100 cm3的EVT患者中,无一例预后良好。

研究发现,大面积缺血性中风患者接受EVT治疗可获得较好预后,但效果随中风体积和治疗时间的增加而显著下降。

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createdName=仁医06, createdTime=Mon Jul 13 13:47:00 CST 2020, time=2020-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1692066, encodeId=1e95169206661, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Sat Feb 22 21:47:00 CST 2020, time=2020-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893197, encodeId=c688189319e26, 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=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Apr 17 02:47:00 CST 2020, time=2020-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000838, encodeId=0a522000838ee, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sun Jan 05 19:47:00 CST 2020, time=2020-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1314277, encodeId=22c313142e72a, content=<a href='/topic/show?id=585189089f4' target=_blank style='color:#2F92EE;'>#血栓切除#</a>, beContent=null, objectType=article, 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time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481020, encodeId=f62c14810205d, content=<a href='/topic/show?id=09498955872' target=_blank style='color:#2F92EE;'>#血管内血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89558, encryptionId=09498955872, topicName=血管内血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa8d7728463, createdName=1179102698_36768928, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500604, encodeId=df26150060454, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538080, encodeId=c71b1538080b9, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1877187, encodeId=7c2b18e718737, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Sep 19 08:47:00 CST 2019, time=2019-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1954518, encodeId=510a195451876, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44048, encryptionId=7a804404823, topicName=大面积)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, 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time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481020, encodeId=f62c14810205d, content=<a href='/topic/show?id=09498955872' target=_blank style='color:#2F92EE;'>#血管内血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89558, encryptionId=09498955872, topicName=血管内血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa8d7728463, createdName=1179102698_36768928, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500604, encodeId=df26150060454, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1538080, encodeId=c71b1538080b9, content=<a href='/topic/show?id=e835226210e' target=_blank style='color:#2F92EE;'>#中风患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22621, encryptionId=e835226210e, topicName=中风患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1b5612933772, createdName=sunylz, createdTime=Fri Aug 09 09:47:00 CST 2019, time=2019-08-09, status=1, ipAttribution=)]
    2020-01-05 yinhl1978
  6. 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  7. 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Stroke:葡萄糖改变急性卒中患者血管内血栓切除术的效果

由此可见,与标准治疗相比,EVT改善了卒中预后,无论血糖水平如何,但在较低葡萄糖水平下治疗效果较大,显著的相互作用持续高达90至100mg/dL(5.0-5.5 mmol/L)。在大血管卒中后严格控制葡萄糖是否能提高EVT的疗效需要进行适当的检测。

Stroke:轻度卒中患者的血管内血栓切除术

血管内血栓切除术(EVT)对大血管闭塞的急性缺血性卒中和美国国立卫生研究院卒中量表(NIHSS)≥6的患者有效。然而,EVT对轻度大血管闭塞(NIHSS<6)的获益尚不确定。Stroke发表的一项最新研究评估了大血管闭塞的轻度卒中患者中EVT的疗效和安全性。

JAHA:血管内血栓切除术治疗急性基底动脉闭塞

由此可见,血管内血栓切除术治疗急性BAO疗效确切、安全。年龄、国家卫生研究院卒中量表基线得分、糖尿病和实质性血肿与更好的结局相关。该研究表明支架-回收器在吸入血栓切除术治疗急性BAO方面没有优势。

JACC Cardiovasc Inte:急性缺血性卒中血管内治疗后再入院率高

既往随机试验表明,血管内血栓切除术(EVT)可改善患者预后,JACC:Cardiovascular Interventions发表的一项研究旨在探讨EVT术后30天非选择性再入院率、预测因素和原因。