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内血管血栓切除术与急性基底动脉阻塞中风的医疗管理在老年人中
Huanwen Chen1,2,3, Marco Colasurdo4, Mihir Khunte5,6
1From the National Institute of Neurological Disorders and Stroke (H.C.), National Institutes of Health, Bethesda, Maryland.
AJNR. American journal of neuroradiology
|August 24, 2024
概括
血管内血栓切除术 (EVT) 没有改善老年基底动脉封闭 (BAO) 中风患者的住院结果,也没有增加内出血风险. 在不接受IV血栓溶解的患者中,EVT可能有益.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 老年医学 老年医学
背景情况:
- 在老年患者中,基底动脉阻塞 (BAO) 中风带来了独特的挑战.
- 血管内血栓切除术 (EVT) 在这个人群中的作用仍然不确定.
- 对于老年BAO中风的EVT现有数据是有限的.
研究的目的:
- 评估EVT在老年患者 (80岁以上) 中的安全性和有效性,这些患者患有BAO中风.
- 为了在这个人群中比较EVT和医疗管理 (MM) 之间的结果.
- 确定影响老年人BAO中风EVT有效性的因素.
主要方法:
- 美国2016-2021年全国住院患者样本的回顾性分析.
- 包括老年患者 (80岁以上) 的BAO和NIHSS得分≥5.5.
- 倾向性得分匹配 (PSM) 用于比较EVT与MM,分析出院回家,死亡率和内出血 (ICH).
主要成果:
- 与PSM后的MM相比,EVT与改善的家庭出院率 (17.5%与12.2%) 或住院死亡率 (31.5%与32.9%) 不相关.
- EVT显著增加了ICH的风险 (18.2%与7.3%相比).
- 在不接受IV血栓溶解 (IVT) 的患者中,EVT与更高的家庭出院率 (21.5%与11.5%) 有关,但在接受IVT的患者中并非如此.
结论:
- 在老年BAO中风患者中,EVT似乎没有改善住院结果,并且与增加ICH风险有关.
- 在不接受IVT的老年BAO中风患者中,EVT可能是有益的治疗方法.
- IVT似乎对EVT和家庭放电之间的关联产生了负面调节.
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