对中风进行血栓切除的试验,具有不受限制的大小的大型心脏病发作
Vincent Costalat1, Tudor G Jovin1, J F Albucher1
1From the Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier (V.C.), the Departments of Neurology (J.F. Albucher) and Neuroradiology (C. Cognard), Hôpital Pierre Paul Riquet, and Toulouse Clinical Investigations Centers 1436 (J.F. Albucher, C. Cognard), Toulouse, the Departments of Neurology (H.H.) and Neuroradiology (N.N.), Hôpital Salengro, and the Department of Biostatistics, Centre Hospitalier Universitaire (CHU) Lille (A.D., J.L.), Lille, the Department of Neuroradiology, Hôpital central, L'unité d'Imagerie Adaptative Diagnostique et Interventionnelle, INSERM Unité 1254 (B. Gory), and the Department of Neurology, Hôpital central, Centre d'investigation clinique Plurithématique 1433, INSERM Unité 1116 (S.R.), Nancy, the Departments of Neuroradiology (G.M.) and Neurology (I.S.), Hôpital Pellegrin, Bordeaux, the Department of Neuroradiology, Hôpital Foch, Suresnes (F.D.M.), the Departments of Neurology (M.A.) and Neuroradiology (G.B.), Hôpital Bretonneau, Tours, the Departments of Neurology (M.O.) and Neuroradiology (M.P.), Hôpital Fondation Adolphe de Rothschild, the Departments of Neurology (G.T.) and Neuroradiology (O.N.), Groupe Hospitalier Universitaire Paris, Centre Hospitalier Sainte-Anne, INSERM Unité 1266, the Departments of Neuroradiology (F.C.) and Neurology (S.A.), Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), the Departments of Neuroradiology (L. Spelle) and Neurology (C.D.), Hôpital Bicêtre, AP-HP, the Departments of Neurology (M. Mazighi) and Neuroradiology (E.H.), Hôpital Lariboisière AP-HP, and INSERM Unité 1266 (C.A.), Paris, the Department of Neuroradiology, Nantes Université, CHU Nantes (R.B.), INSERM Unité Mixte de Recherche 1087, Centre National de la Recherche Scientifique, University of Nantes, L'institut du Thorax (R.B.), and Clinique Neurologique, Hôpital G.R. Laennec CHU Nantes (B. Guillon), Nantes, the Departments of Neurology (S.G.) and Neuroradiology (A.P.-P.), CHU d'Angers, Angers, the Departments of Neuroradiology (O.F.E.) and Neurology (T.-H.C.), Hospices Civils de Lyon, Groupement Hospitalier Est Hôpital Pierre Wertheimer, Lyon, the Departments of Neuroradiology (S.V.) and Neurology (M.L.), CHU Poitiers, Site de La Milétrie, Poitiers, the Stroke Unit (L. Suissa) and the Department of Neuroradiology (H.B.), Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, the Departments of Neuroradiology (J.-C.G.) and Neurology (S.T.), Centre Hospitalier Régional Universitaire (CHRU) Brest, Hôpital de la Cavale Blanche, Brest, the Departments of Neurology (C.L.) and Neuroradiology (C. Chivot), CHU Amiens-Picardie, Amiens, the Departments of Neurology (F.M.-M.) and Neuroradiology (C.M.), CHU Limoges, Dupuytren, Limoges, the Departments of Neurology (O.O.-W.) and Neuroradiology (C.P.), CHU Rouen, Rouen, the Departments of Neurology (V.W.) and Neuroradiology (R.P.), CHRU Strasbourg, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, the Departments of Neurology (A.F.) and Neuroradiology (E.C.), CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, the Departments of Neuroradiology (F.R.) and Neurology (Y.B.), CHU Dijon-Bourgogne, Hôpital François Mitterrand, Dijon, and the Department of Neurology, Hôpital Foch, Suresnes (B.L.), and the Department of Neurology, Hôpital Gui de Chauliac, Montpellier (C.A.) - all in France; Cooper Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ (T.G.J.); the Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (P.C.), and the Department of Neurology, Hospital Clínic de Barcelona (A.R.), Barcelona, the Department of Radiology, Hospital Universitario Central de Asturias, Oviedo (E.L.-C., P.V.), the Department of Neurology Hospital Germans Trias i Pujol, Badalona (M. Millán), Hospital Clínico Universitario de Valladolid, Valladolid (J.F. Arenillas), and the Department of Neurology, Hospital Universitario Cruces, Baracaldo (M.M.F.) - all in Spain; and the Department of Neurology, University of Southern California (N.S.), and the Department of Neurology, UCLA (D.S.L.) - both in Los Angeles.
血管内血栓切除术显著改善功能结果,并降低了急性中风的大型心脏病发作患者的死亡率. 然而,与仅仅医疗保健相比,它增加了症状性脑内出血的风险.
科学领域:
- 神经学 神经学
- 干预性神经辐射学
- 治疗急性中风的方法
背景情况:
- 血栓切除术对急性中风与大心脏病发作的疗效以前没有得到充分研究.
- 急性中风患者的大型心脏病发作带来了独特的治疗挑战.
- 确定大前循环堵塞的最佳治疗策略至关重要.
研究的目的:
- 评估内血管血栓切除术在急性缺血性中风和大心脏病发作患者中的有效性.
- 为了比较血栓切除术加医疗保健和仅医疗保健之间的功能结果和死亡率.
- 评估这一患者群体中血栓切除术的安全性,包括症状性脑内出血.
主要方法:
- 一个随机对照试验,比较了内血管血栓切除术加医疗保健与单独医疗保健.
- 在发病后6.5小时内出现近端前部循环封闭和大心脏病发作 (ASPECTS ≤5) 的患者被纳入.
- 主要结局是90天后修改的兰金度量得分;安全结局包括死亡率和症状性脑内出血.
主要成果:
- 血栓切除术显著改善了功能结果,在对照组中,中位数修改的兰金度表得分为4相对于6 (P<0.001).
- 血栓切除组的90天死亡率 (36.1%) 与对照组 (55.5%) 相比较低.
- 血栓切除组 (9.6%) 的症状性脑内出血发生的频率高于对照组 (5.7%).
结论:
- 血管内血栓切除术加上医疗护理为患有大心脏病发作的急性中风患者提供了优越的功能结果和降低死亡率.
- 血栓切除术的好处必须与症状性脑内出血的风险增加相对衡量.
- 这项研究提供了重要的证据,支持在以前较少研究的中风患者中进行血栓切除术.
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