JAHA:卒中前残疾的急性缺血性脑卒中患者血管内治疗疗效分析

2021-07-23 MedSci原创 MedSci原创

接受EVT的患者比接受内科治疗的患者可获得更好的功能结局。因此,仅以卒中前残疾为由拒绝EVT可能会失去获得良好结局的最佳机会。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究比较了卒中前残疾的大血管闭塞卒中患者血管内治疗(EVT)和内科治疗的结局。


 
在日本前瞻性、多中心、全国范围内登记的2420例急性脑卒中大血管闭塞患者中,研究人员分析了卒中前改良Rankin评分为2-4分的颈内动脉或大脑中动脉M1闭塞的患者。该研究的主要疗效结局为良好结局,定义为3个月后改良的Rankin量表评分至少恢复到卒中前水平。该研究的安全性结局包括有症状的颅内出血。

该研究共纳入了339名患者(237名女性;年龄中位数为85岁[四分位范围(IQR)为79-89];分析卒中前改良Rankin量表中位评分为3分[IQR为2-4]。175例患者行EVT(51.6%;机械血栓切除术,n=139)。EVT组患者较内科治疗组患者年轻(p<0.01),卒中前改良Rankin评分较低(p<0.01)。

EVT组28.0%的患者和内科治疗组10.9%的患者获得了良好结局(p<0.01)。EVT与良好结局相关(调整后比值比为3.01;95%置信区间为1.55-5.85)。EVT组(4.0%)和内科治疗组(4.3%)患者症状性颅内出血率相似(p=1.00)。
 
由此可见,接受EVT的患者比接受内科治疗的患者可获得更好的功能结局。因此,仅以卒中前残疾为由拒绝EVT可能会失去获得良好结局的最佳机会。
 
原始出处:

Kanta Tanaka.et al.Endovascular Therapy for Acute Ischemic Stroke in Patients With Prestroke Disability.J AM HEART ASSOC.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.121.020783

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  5. 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  6. 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  7. 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createdBy=a12645, createdName=智智灵药, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268586, encodeId=f82e126858613, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026920, encodeId=4e2f102692096, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1679168, encodeId=d4ef16e916817, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Mar 17 15:38:42 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010892, encodeId=5c09201089288, content=<a href='/topic/show?id=f880360114f' target=_blank style='color:#2F92EE;'>#卒中前残疾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36011, encryptionId=f880360114f, topicName=卒中前残疾)], attachment=null, authenticateStatus=null, createdAvatar=, 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createdBy=a12645, createdName=智智灵药, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268586, encodeId=f82e126858613, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026920, encodeId=4e2f102692096, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033049, encodeId=aa65103304996, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-25 zhaohui6731
  9. 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createdBy=a12645, createdName=智智灵药, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268586, encodeId=f82e126858613, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Sun Jul 25 14:38:42 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026920, encodeId=4e2f102692096, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033049, encodeId=aa65103304996, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-24 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!

    0

  10. 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createdBy=f0620, createdName=健健, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033049, encodeId=aa65103304996, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sat Jul 24 02:38:42 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-24 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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JNNP:基底动脉闭塞的桥接与直接血管内治疗

急性缺血性脑卒中的血管内治疗因颅内大血管闭塞引起的前部缺血性脑卒中而广为接受。 80%以上的主要血管内临床试验患者在血管内治疗前接受了重组组织型纤溶酶原激活剂(rt-PA)静脉治疗,支持血管内治疗前应

Neurology:卒中患者想要获得好预后,血管内治疗开始时间很重要

对于AIS患者,早上开始EVT可以改善中期功能,而在下班时段进行EVT可以降低患者中期功能预后。

JAMA:单独血管内治疗vs溶栓后血管内治疗对前循环大血管闭塞中风患者90天功能预后的影响

对于发病后4.5小时内,因近端前循环闭塞而导致缺血性脑卒中的患者,与静脉注射阿替普酶后血管内治疗相比,单独进行血管内治疗可达到的90天功能预后独立率与联合治疗相当

Eur Heart J:外周动脉疾病患者经血管内和手术血运重建的长期结局比较

尽管两种治疗策略的长期MALE风险相当,但经手术血管重建具有降低长期死亡率的优势。

NEJM:血管内治疗对基底动脉闭塞卒中患者的疗效及安全性研究

对于基底动脉闭塞卒中患者,血管内治疗与标准卒中治疗手段相比,在改善患者预后方面无显著优势,但本试验不排除血管内治疗的实质益处,需要更大规模的试验来确定血管内治疗对基底动脉阻塞性卒中的有效性和安全性。

Lancet Neurology:急性缺血性卒中(BP-TARGET)血管内治疗成功后强化降压的安全性和有效性:一项多中心、开放标签、随机对照试验

急性缺血性卒中的血管内治疗显示出巨大的疗效,再灌注率超过80%。尽管有这种疗效,但超过一半的患者不能达到功能独立。