较轻的基线严重度的大血管封闭性中风显示出更好的附带资产和减少了来自血栓切除术转移延迟的伤害
Hannah Rowling1,2, Dominic Italiano3, Leonid Churilov1,3
1Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
概括
大血管封闭性 (LVO) 卒中中医院间转移延迟对严重病例的结果产生负面影响,但对较轻的病例的影响不大. 较轻度的LVO中风患者表现出更好的附带循环,这可能解释了这种差异.
科学领域:
- 神经学 神经学
- 干预性放射学 干预性放射学
- 公共卫生 公共卫生
背景情况:
- 大血管闭塞 (LVO) 中风患者有较轻的症状往往需要内血管血栓切除术.
- 医院前分类工具难以识别这些患者,导致医院间转移.
- 转移延迟对较轻微的LVO中风的结果的影响尚不清楚,可能是由于更好的附带循环.
研究的目的:
- 为了确定医院间转移延迟是否会对LVO中风患者的结果产生不同的影响,LVO中风患者的轻度与重度的基线缺陷.
- 调查与基线中风严重程度相关的附带循环的成像标志物.
主要方法:
- 来自两个澳大利亚血栓切除中心的注册数据的回顾性分析.
- 包括1210名接受血栓切除术的LVO患者,按基线严重程度分类 (NIHSS<10对≥10).
- 主要结局:90天后的功能独立 (修改的兰金尺度0-2或基线). 对CT-perfusion数据的附带标记的二次分析.
主要成果:
- 转移的患者的结果比直接呈现的患者更差,具有严重的基线缺陷 (aOR 0.759),但没有较轻微的缺陷 (aOR 1.357,p-相互作用=0.122).
- 较轻度的LVO患者显示出明显更好的附带循环标志物:较小的缺血核心体积,较高的 perfusion mismatch比率和较低的hyperfusion强度比率.
- 在包括的LVO患者中,22.6%的患者的发病严重程度较低.
结论:
- 医院间转移延迟与严重的LVO中风的较差结果有关,但在较轻的病例中并非如此.
- 在较轻度的LVO中风患者中改善的附带循环可以减轻转移延迟的负面影响.
- 由于这些保护因素,目前对较轻度的LVO中风的医院前查限制可能不会显著损害患者的结果.
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