系统性血栓溶解后的症状性病变的 Carotid 干预的并发症
Tiffany R Bellomo1, Charles DeCarlo1, Srihari K Lella1
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Annals of vascular surgery
|May 31, 2024
概括
系统性血栓溶解 (ST) 不会增加心动脉内关节切除术 (CEA) 或输血性心动脉支架 (tfCAS) 后的并发症. 早期干预对于接受ST的患者来说是安全的,避免因中风风险而延迟.
科学领域:
- 血管外科 血管外科
- 神经学 神经学
- 干预心脏病学 干预心脏病学
背景情况:
- 在接受全身血栓溶解 (ST) 治疗的患者中, carotid endarterectomy (CEA) 和 transfemoral carotid stenting (tfCAS) 后的并发症没有得到充分记录.
- 在施用ST时,这些程序的安全性和有效性存在有限的数据.
研究的目的:
- 调查系统性血栓溶解 (ST) 是否与 carotid endarterectomy (CEA) 或 transfemoral carotid stenting (tfCAS) 后的术后并发症增加有关.
- 评估早期动脉干预在接受了ST的患者的安全性.
主要方法:
- 查询了2007年至2019年间接受CEA或tfCAS的症状患者的前性维护数据库.
- 分析的结果包括出血并发症,需要重新干预,中风和死亡.
- 倾向性得分的计算是为了调整手术前患者的因素和ST和非ST组之间的混变量.
主要成果:
- 在1,139名患者中,56人 (5%) 接受了ST.ST患者更有可能出现中风,并且手术前的Rankin分数更高.
- 未调整的出血/返回OR率相似 (3%对3%) 和中风率相似 (4%对3%). 术后死亡率在ST组中较高 (5%对比1%).
- 在调整后,ST与术后出血/重复手术 (OR 0.37) 或中风 (OR 0.62) 的几率增加无关.
结论:
- 系统性血栓溶解 (ST) 不会增加CEA或tfCAS后并发症的风险.
- 接受ST治疗的患者在控制混杂因素后,与非ST患者相比,局部并发症和中风的发病率相似.
- 在ST患者中,早期动脉干预是安全的,由于再发中风的高风险,应避免延迟.
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