在患有中风前残疾患者的大血管封闭的延长时间窗口内血管内疗法
Kanta Tanaka1,2, Hiroshi Yamagami3, Muhammad M Qureshi4
1Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
Journal of stroke
|June 5, 2024
概括
扩展窗口内血管治疗 (EVT) 对大血管封闭 (LVO) 和中风前残疾患者有益. 很大一部分重新获得了独立性,这表明EVT是这个群体的可行选择.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 公共卫生 公共卫生
背景情况:
- 大血管闭塞 (LVO) 卒中需要及时干预.
- 对内血管治疗 (EVT) 的延长时间窗口越来越多地被研究.
- 脑卒中前的残疾状态可以影响治疗决策和治疗结果.
研究的目的:
- 为了比较LVO中风患者在延长时间窗口 (6-24小时) 中EVT的结果.
- 评估中风前残疾对EVT后功能独立性的影响.
- 评估患有或没有中风前残疾的患者恢复中风前功能状态的速度.
主要方法:
- 一项跨国研究 (CT for Late Endovascular Reperfusion) 的分析,其中包括2,231名患有LVO.患者.
- 患有中风前修改的兰金尺度 (mRS) 评分为0-4的患者从最后一次看病6-24小时后接受了EVT.
- 90天后的结果 (功能独立或恢复中风前的mRS) 被与患有 (mRS 2-4) 和没有 (mRS 0-1) 中风前残疾的患者进行比较.
主要成果:
- 25%的患者在中风前有残疾 (mRS 2-4).
- 与残疾患者 (16.5%) 相比,没有中风前残疾的患者具有更高的功能独立率 (44.1%).
- 总的来说,30.7%的前中风残疾患者实现了功能独立或恢复到前中风的mRS得分,而没有残疾的44.1% (P<0.001).
- 脑卒中前的残疾与实现功能独立或恢复脑卒中前的mRS的几率较低无关 (aOR 0.73;95% CI 0.43-1.25) .
- 在两组 (6.3%) 中,症状性内出血的发病率相似.
结论:
- 一个显著的百分比的LVO中风患者前中风残疾可以恢复前中风功能状态后EVT在延长的时间窗口.
- 在延长时间窗口中出现LVO的中风前残疾患者应考虑EVT.
- 这项研究支持在更广泛的中风患者中考虑EVT,包括那些先前有功能限制的人.
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