Stroke:既往抗血小板治疗对急性卒中患者血管内治疗后结局的影响

2021-09-21 MedSci原创 MedSci原创

既往APT不影响血管内治疗后的血管造影和功能结局,因此,不应考虑急性血运重建策略。

既往使用抗血小板治疗(APT)对接受血管内治疗的急性缺血性卒中患者结局的影响尚未明确。

近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在比较了卒中发作前接受或未接受APT患者的血管内治疗的手术和临床结局。

研究人员分析了来自法国正在进行的前瞻性多中心血管内治疗的法国缺血性卒中登记处的两个组别:既往接受APT(APT+)的患者和未接受过APT(APT-)的血管内治疗患者,同时接受或没接受静脉溶栓。研究人员使用纳入了中心作为随机效应的多级混合效应Logistic模型根据APT亚组比较了血管造影(手术结束时的再灌注率、手术并发症)和临床(良好和极好的结局、90天全因死亡率和出血并发症)结局。针对预先指定的混杂因素(年龄、入院国立卫生研究院卒中量表评分、阿尔伯塔卒中计划早期CT评分、静脉溶栓和从发病到穿刺的时间)以及有意义的基线组间差异对比较进行了调整。

该研究共分析了2939名患者,其中877名(29.8%)患者曾接受过APT。既往APT患者的年龄较大,血管危险因素、心源性卒中机制和卒中前残疾更常见。完全再灌注率(APT-组37.9% vs. APT+组42.7%;aOR为1.09[95%CI为0.88-1.34];P=0.41)和围手术期并发症(16.9% vs. 13.3%;aOR为0.9)[95%CI为0.7-1.2];P=0.66)两组之间没有差异。有症状的脑出血(aOR为0.93[95%CI为0.63-1.37];P=0.73),3个月的良好临床结局(改良Rankin量表评分为0-2;aOR为0.98[95%CI为0.77-1.25];P=0.89)和90天死亡率(aOR为0.95[95%CI为0.72-1.26];P=0.76)在各组之间没有差异。

由此可见,既往APT不影响血管内治疗后的血管造影和功能结局,因此,不应考虑急性血运重建策略。

原始出处:

Marie Couture.et al.Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.034670

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在急性缺血性卒中患者中,约有七分之一的患者在卒中发病后数小时内就出现了肺部感染的影像学征象,这些患者发生肺炎或死亡的风险较高。他们应尽早使用抗生素可能会获得更好的结局。

Stroke:脑电图可能改善急性卒中和大血管闭塞的诊断

将脑电图数据添加到临床指标中可改善对急性卒中/TIA以及LVO急性卒中的诊断。在急诊科中快速采集干电极脑电图是可行的,值得用于院前评估。

Stroke:卒中病因学会改变急性卒中患者的血管内治疗效果

由此可见,这些结果提供了与非心脏栓塞性LVO相比,心脏栓塞性LVO患者接受血管内治疗更有效的证据。

Stroke:脑淀粉样血管病的急性卒中患者血管内治疗效果分析

血管内血栓切除术联合或不联合溶栓对伴有CAA的急性缺血性卒中患者都有益,但与较差的功能结局相关。

Stroke:急性卒中治疗和住院死亡率的城乡差异

城乡居民的预期寿命差距正在扩大,但根本原因尚不完全清楚。先前的研究表明农村地区的个人卒中治疗可能更糟,卒中治疗的技术进步可能对更多农村地区的居民产生不成比例的影响。近日,心血管疾病领域权威杂志Stro