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针对急性缺血性中风的血栓切除术后直接缺血后调节的安全性和耐受性

Longfei Wu¹, Ming Wei^2,3,4, Bohao Zhang⁵

¹Department of Neurology, Xuanwu Hospital (L.W., Bowei Zhang, H.S., W.Z.), Capital Medical University, Beijing, China.

|July 27, 2023

概括

直接缺血后调节 (IPostC) 在经过血栓切除术的急性缺血性中风患者中是安全且耐受良好的. 这种神经保护方法在中风治疗中表现有前途,因此需要进一步研究其有效性.

科学领域:

神经学神经学
心血管医学心血管医学
干预神经病学干预神经病学

背景情况:

缺血后调节 (IPostC) 是一种神经保护策略,在实验中风模型中被证明可以减轻缺血-再输液损伤.
急性缺血性中风的治疗通常涉及血栓切除术,这可能与缺血-再输液损伤有关.

研究的目的:

在狗模型中评估直接IPostC的安全性和耐受性,以及在经过血栓切除术的急性缺血性中风患者中评估.
为了确定在患者中升级IPostC协议的可行性.

主要方法:

一个狗模型通过在前脊髓动脉中重复的气球膨胀/膨胀 (五分钟缺血/五分钟再注血的四个周期) 进行IPostC.
在一次3+3剂量升级试验中,在血栓切除术后患有急性缺血性中风的人类患者中,评估了IPostC,并逐渐增加缺血/再输血持续时间 (0-5分钟×4周期).
安全终点包括主要不良事件,如血管穿孔,破裂,剖析,再封闭,血管和血栓事件.

主要成果:

在狗中,IPostC没有诱导主要的血管损伤;仅有一例轻微的内脏损伤被记录在他的病理学上.
在18名人类患者中,不断升级的IPostC持续时间被很好地容忍,没有重大不良事件或显著的耐受性问题 (兴奋,不适).
血栓切除术后的内出血发生在27.8%的患者 (1/5有症状);50%的患者在3个月后实现功能独立.

结论:

直接IPostC,应用为4个周期的5分钟缺血/5分钟再注血,是安全的,可行的,在急性缺血性中风患者接受血栓切除治疗耐受良好.
需要进一步的研究来确认直接IPostC在这个患者群体中的安全性和初步疗效.

关键词:

缺血性后调节缺血后调节缺血性中风中风神经保护神经保护转流伤害的伤害是因为再流.进行血栓切除术 (thrombectomy).

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