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Updated: Aug 1, 2026

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Published on: November 26, 2013
非对比CT选择性血栓切除 vs 晚窗前部大血管阻塞的医疗管理
Thanh N Nguyen1, Raul G Nogueira1, Muhammad M Qureshi1
1From the Department of Neurology (T.N.N., P.K., Z.M.), and Department of Radiology (T.N.N., M.M.Q., M.A., P.K., Z.M.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), Neurosurgery, University of Pittsburgh Medical Center, PA; Department of Radiation Oncology (M.M.Q.), Boston Medical Center, MA; Department of Neurology (S. Nagel), Klinikum Ludwigshafen, Ludwigshafen, Germany; Department of Neurology (S. Nagel, P.A.R.), Heidelberg University Hospital, Germany; Interventional Neuroradiology Laboratory (J.R., D.R.), Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Quebec, Canada; Department of Neurology (J.D., L.V., A.W., R.L.), UZ Leuven; Laboratory for Neurobiology (J.D., L.V., A.W., R.L.), KU Leuven, Belgium; Department of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (V.P., S.W.), and Dresden Neurovascular Center (V.P., S.W., D.P.O.K.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Neurology (A.D., F.B.), Hôpital Civil Marie Curie, Charleroi, Belgium; Department of Neurology (P.M., D. Strambo), Lausanne University Hospital and University of Lausanne, Switzerland; Department of Neurology (M. Ribo, M.O.-G., M. Requena), Hospital Vall d'Hebron, Barcelona, Spain; Neuroscience and Stroke Program (O.O.Z., E.L.), Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH; Department of Neurology (J.E.S.), University of Chicago, IL; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Atlanta, GA; Department of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland; Department of Neurology (H.H., F.C., C.C.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France; Department of Radiology (M.A.M., J.J.), Heidelberg University Hospital, Germany; Division of Interventional Neuroradiology (A.S.P.), University of Massachusetts Memorial Medical Center, Worcester; Department of Diagnostic and Interventional Neuroradiology (J.K., A.M.), University Hospital Bern, Switzerland; Department of Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (M.A.J., S.F.Z., A.C.C.), University of Toledo, OH; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; Department of Neurology (M.F., S.O.-G.), University of Iowa, Iowa City; Department of Radiology (P.V., E.P.), Helsinki University Hospital, University of Helsinki, Finland; Institute of Neuroradiology (D.P.O.K.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Neurology (L.S., S.Y.), Rhode Island Hospital, Providence; Department of Neurology (Z.Q.), 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Neurology (H.E.M.), State University of New York, Syracuse; Department of Neurology (W.H.), The First Affiliated Hospital of USTC, China; Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurology (U.F.), University Hospital Basel, Switzerland; Department of Neurology (U.F.), University Hospital Bern, Switzerland; and Department of Neurology (T.G.J.), Cooper University Hospital, Camden, NJ.
在延长6-24小时窗口内,使用非对比CT (NCCT) 选择的大血管封闭性中风的内血管治疗 (EVT),与医疗管理相比,显著降低了残疾和死亡率. 这支持NCCT作为一个包容性选择工具.
科学领域:
- 神经学 神经学
- 干预性放射学 干预性放射学
- 脑卒中医学 脑卒中医学
背景情况:
- 对于大血管封闭性 (LVO) 中风的内血管治疗 (EVT) 的有效性存在不确定性,该中风超过6小时.
- 非对比CT (NCCT) 和CT血管图 (CTA) 用于LVO检测,但它们在长时间窗口中选择患者接受EVT方面的作用仍在争论中.
研究的目的:
- 为了评估由NCCT选择EVT的LVO中风患者的临床结果,与在延长6-24小时时间窗口中医疗管理的患者相比.
- 为了确定NCCT是否是选择患者在晚期时间窗口中接受EVT的合适工具.
主要方法:
- 一项涉及10个国家的66个地点的跨国队列研究.
- 包括连续出现近端前侧LVO中风的患者,在最后一次看好后6-24小时内出现 (TSLW).
- 主要终点:修改的兰金尺度 (mRS) 评分的90天顺序转移,使用逆概率治疗权重 (IPTW) 和多变量方法进行分析.
主要成果:
- 616名患者接受了EVT (由NCCT选择),223人接受了医疗管理.
- 通过NCCT进行的EVT选择显示了更有利的90天mRS转移 (OR 1.99) 和更高的功能独立性 (mRS 0-2:40.1%对18.4%).
- 在EVT组中,90天死亡率较低 (23.9%对32.3%,或0.61).
结论:
- 在延长时间窗口中,近端前侧LVO患者从NCCT和CTA选择的EVT中受益,体验到减少残疾和死亡率.
- 在延长的时间窗口中,NCCT作为一种更简单,更具包容性的方法,用于在延长的时间窗口中为EVT选择患者.
- 第三类证据支持基于NCCT的血栓切除术用于6-24小时的缺血性中风,与医疗管理相比,显示残疾和死亡率降低.
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