Stroke:高级神经影像学为卒中患者MT选择提供指导价值

2018-11-03 国际循环编辑部 国际循环

在症状发作的第一个6小时内,临床医生可应用高级影像学技术指导可行机械血栓切除术(MT)治疗的缺血性卒中患者的选择。但越来越多的研究证据表明,高级神经影像学技术是非常有价值且与非时间依赖性的预后因素。

在症状发作的第一个6小时内,临床医生可应用高级影像学技术指导可行机械血栓切除术(MT)治疗的缺血性卒中患者的选择。但越来越多的研究证据表明,高级神经影像学技术是非常有价值且与非时间依赖性的预后因素。

近期,Stroke发表的一项最新研究探讨高级神经影像学对卒中患者MT选择的指导价值。研究者对评估采用高级神经影像学技术进行患者选择对3个月功能独立性(改良Rankin量表评分0~2分)、良好的功能性结局(改良Rankin评分0~1分)、全因死亡率及功能改善(通过改良Rankin量表评分进行比较分析)情况影响的随机临床试验进行系统回顾和荟萃分析,将灌注成像存在低灌注区的患者与灌注成像未发现低灌注区的患者以及未行灌注成像的患者进行比较。

共计有10项相关随机临床试验,共计2227例患者,平均年龄为67岁。其中5项采用高级成像技术进行患者选择。与采用常规神经成像技术的研究相比,采用高级神经成像技术的研究中MT对3个月功能独立性[OR值:3.79 vs. 1.89,P<0.001]、功能结局良好(OR值:3.16 vs. 1.75,P=0.04)、功能改善(OR值:2.66 vs. 1.60,P=0.007)的治疗作用更强;MT后实现成功再灌注的汇集发生率更高(P=0.003)。不过,两组死亡率及症状性颅内出血发生率并无差异。此外,所有报告的分析中均未见异质性证据。

该间接比较提示,采用高级神经成像对急性缺血性卒中患者进行MT的选择有助于改善临床结局。此外,采用高级神经成像进行适合MT治疗者的选择及预后预测并不受症状发作时间的影响。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1720268, encodeId=75991e20268fa, 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=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Thu Nov 08 16:47:00 CST 2018, time=2018-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359770, encodeId=45a9359e7038, content=实用性非常强的学习资料,值得借鉴与学习的临床,涨知识!获益匪浅,感谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Fri Feb 01 23:58:07 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2019753, encodeId=5fd42019e5385, content=<a href='/topic/show?id=5ecde428074' target=_blank style='color:#2F92EE;'>#神经影像#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74280, encryptionId=5ecde428074, topicName=神经影像)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ab72500038, createdName=124985dbm06(暂无昵称), createdTime=Wed Apr 17 10:47:00 CST 2019, time=2019-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026206, encodeId=71c4102620668, 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=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Nov 03 16:47:00 CST 2018, time=2018-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=351380, encodeId=7f5f35138082, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Sat Nov 03 13:58:15 CST 2018, time=2018-11-03, status=1, ipAttribution=)]
    2019-02-01 13718711b3m

    实用性非常强的学习资料,值得借鉴与学习的临床,涨知识!获益匪浅,感谢分享!

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1720268, encodeId=75991e20268fa, 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=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Thu Nov 08 16:47:00 CST 2018, time=2018-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359770, encodeId=45a9359e7038, content=实用性非常强的学习资料,值得借鉴与学习的临床,涨知识!获益匪浅,感谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Fri Feb 01 23:58:07 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2019753, encodeId=5fd42019e5385, content=<a href='/topic/show?id=5ecde428074' target=_blank style='color:#2F92EE;'>#神经影像#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74280, encryptionId=5ecde428074, topicName=神经影像)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ab72500038, createdName=124985dbm06(暂无昵称), createdTime=Wed Apr 17 10:47:00 CST 2019, time=2019-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026206, encodeId=71c4102620668, 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=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sat Nov 03 16:47:00 CST 2018, time=2018-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=351380, encodeId=7f5f35138082, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Sat Nov 03 13:58:15 CST 2018, time=2018-11-03, status=1, ipAttribution=)]
    2018-11-03 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

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    2018-11-03 一天没事干

    很好的学习机会

    0