Stroke:急性缺血性卒中患者血凝块迁移与静脉溶栓相关

2018-11-10 xing.T MedSci原创

由此可见,在EVT前桥接IVT的情况下,血凝块迁移的发生率显著增加,导致EVT无法接触血凝块的比例增加。

在急性大血管闭塞的患者中可观察到血凝块迁移至远端颅内动脉段。据推测,患者接受静脉溶栓(IVT)会增加凝块迁移的风险,并且血管血栓切除术(EVT)会导致难以接触血栓。近日,卒中领域权威杂志Stroke上发表了一篇研究文章,在这项研究中,研究人员的目的是调查EVT前血凝块迁移的发生率及其与IVT之间的关系。

研究人员对2009年至2016年期间患有EVT的患者进行了单中心回顾性分析。接受了IVT治疗和未接受过直接EVT治疗的患者符合临床标准。通过预处理计算机断层扫描血管造影或磁共振血管造影评估血凝块位置,并在计划性血管内血栓切除术前通过数字减影血管造影确定的血凝块位置且进行比较。

在314例患者中,43例患者发生血凝块迁移(13.7%)。在使用EVT桥接IVT的患者中,血凝块迁移的比例为18.7%(39/209),而直接EVT的患者为3.8%(4/105)(P=0.001)。在使用EVT的桥接IVT患者中发生血凝块迁移的有39例患者,59.0%(23/39)患者显示血栓难以接触,而直接EVT组血凝块迁移病例占25.0%(1/4)(P=0.011)。

由此可见,在EVT前桥接IVT的情况下,血凝块迁移的发生率显著增加,导致EVT无法接触血凝块的比例增加。

原始出处:

Yifan Ren,et al.Clot Migration Is Associated With Intravenous Thrombolysis in the Setting of Acute Ischemic Stroke.Stroke. 2018.https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022751

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    2018-12-02 fusion
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likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Nov 13 12:52:15 CST 2018, time=2018-11-13, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1697801, encodeId=83bf169e801f1, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sun Dec 02 15:18:00 CST 2018, time=2018-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720269, encodeId=23721e202694c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, 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encodeId=bc6b352e734d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568f2484953, createdName=华中南瓜, createdTime=Fri Nov 16 15:22:56 CST 2018, time=2018-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352664, encodeId=06d93526648f, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Thu Nov 15 12:06:28 CST 2018, time=2018-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352462, encodeId=20f93524621e, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Nov 13 12:52:15 CST 2018, time=2018-11-13, status=1, ipAttribution=)]
    2018-11-16 华中南瓜

    学习

    0

  9. 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likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Nov 13 12:52:15 CST 2018, time=2018-11-13, status=1, ipAttribution=)]
    2018-11-15 衣带渐宽

    学习

    0

  10. 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likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Nov 13 12:52:15 CST 2018, time=2018-11-13, status=1, ipAttribution=)]
    2018-11-13 清风拂面

    谢谢分享学习

    0

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由此可见,早期西酞普兰治疗并未改善前6个月内非抑郁性缺血性卒中患者的功能恢复,尽管在分析人群中观察到临界统计学显著效应。治疗组之间心血管事件的风险相似,西酞普兰治疗耐受性良好。

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由此可见,在符合溶栓条件的AIS患者中,NIHSS可能低估了幕上病变的临床严重程度,相比于恢复预后相似的幕上病变。当基线NIHSS评分超过6时,溶栓治疗对幕下AIS患者的卒中预后影响较小,因此应考虑采用额外治疗,如血管内治疗,来改善卒中预后。

2018 共识建议:脑出血,蛛网膜下腔出血以及急性缺血性卒中患者的目标温度管理

本文为采用改进的Delphi方法确定的针对:脑出血,蛛网膜下腔出血以及急性缺血性卒中患者合并非感染性发热的目标温度管理提出指导意见。