在缺血性中风中,在6到24小时后将EVT添加到通常的护理中,在90天后改善了功能状态
1Morristown Medical Center, Morristown, New Jersey, USA (B.E.).
Annals of internal medicine
|July 3, 2023
概括
与6-24小时内缺血性中风患者的标准护理相比,内血管治疗没有显著的益处,即使在CT血管学上具有良好的附带流量.
科学领域:
- 神经学 神经学
- 干预性神经放射学 干预性神经放射学
- 临床试验 临床试验
背景情况:
- 缺血性中风治疗窗口正在扩大.
- CT血管造影的附带流可以识别那些受益于晚期再注射治疗的患者.
- 在MR CLEAN-LATE试验中,研究了在特定的晚期中风窗口人群中的内血管治疗.
研究的目的:
- 为了确定内血管治疗与标准护理相比的疗效.
- 评估在症状出现后6至24小时出现缺血性中风的患者的治疗.
- 为了特别评估在CT血管学上有附带流的证据的患者.
主要方法:
- 一个多中心,开放标签,盲目的终点,随机控制的第三阶段试验.
- 包括患有缺血性中风和CT血管学在6-24小时内附带流的患者.
- 将内血管治疗 (血栓切除术) 与标准医疗护理进行比较.
主要成果:
- 在内血管治疗组和标准护理组之间,90天后功能性结局 (修改的兰金度量表) 没有显著差异.
- 主要终点没有达到,这表明在这个特定的患者队列中,血栓切除术没有额外的益处.
- 进一步的子组分析探讨了特定患者个人资料中的潜在益处.
结论:
- 内血管治疗对于6-24小时内缺血性中风患者的标准护理并不优越,即使有附带流.
- 这些发现表明,血栓切除术的好处仅限于早期治疗窗口.
- 谨慎的患者选择对于优化中风治疗结果至关重要.
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