脑静脉鼻血栓的内血管治疗:不同内血管程序之间的比较
S Anush Rangarajan1, Dileep Ramachandran1, Tanaya Mishra1
1Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India.
Annals of Indian Academy of Neurology
|May 16, 2024
概括
血管内治疗 (EVT) 为选择的脑静脉鼻血栓症 (CVST) 患者提供了良好的结果,这些患者对医疗治疗不耐药. 与替代EVT程序相比,现场血栓溶解 (IST) 显示出更优异的结果.
科学领域:
- 神经学 神经学
- 干预性放射学 干预性放射学
- 血管医学 血管医学
背景情况:
- 大脑静脉鼻血栓 (CVST) 是一种罕见但可治疗的中风原因.
- 很大一部分CVST患者 (15%) 不对传统的医疗管理做出反应.
- 在耐火性CVST病例中选择患者接受内血管治疗 (EVT) 仍然是一个临床挑战.
研究的目的:
- 分析那些接受CVST的EVT患者的患者资料和结果.
- 确定与耐火CVST中有利结果相关的特定EVT程序.
- 评估EVT在医学上不耐药的CVST患者队列中的疗效和安全性.
主要方法:
- 在一个中心 (2009-2022) 对52名CVST患者进行EVT治疗的回顾性分析.
- 排除仅通过医疗管理治疗的患者.
- 主要结局:3个月后修改的兰金尺度 (mRS) 得分≤2;次要结局包括死亡率,住院和重新入院.
主要成果:
- 头痛是最常见的症状 (84.6%);贫血和高血血是常见的危险因素 (每一个为25.5%).
- 在现场血栓溶解 (IST) 在48.1%的患者中进行,与其他手术 (P=0.04) 相比,取得了明显更好的结果 (mRS ≤2,80%).
- 预测不良结果的预测因素包括中线转移>5毫米和格拉斯哥昏迷尺度<9在EVT之前;女性性别,改变的感觉器和对子细胞出血与不良的出院结果有关.
结论:
- 在精心挑选的,医疗耐药的CVST患者中,EVT可以产生有利的结果.
- 与其他方法相比,现场血栓溶解 (IST) 似乎是CVST的更有效的EVT方法.
- 确定预后因素对于优化耐火性CVST患者的选择和管理至关重要.
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