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机械血栓切除术在老年中风患者的低ASPECT:从STAR的见解

Conor Cunningham¹, Zachary Hubbard¹, Rahim Abo Kasem¹

¹Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Journal of neurointerventional surgery

|January 24, 2025

概括

高龄患者 (≥80) 患有严重中风 (低ASPECTS) 可能受益于内血管血栓切除术 (EVT). 在这个代表性不足的群体中,个性化治疗选择是有利结果的关键.

科学领域:

神经学神经学
干预神经病学干预神经病学
老年人中风中风

背景情况:

老年患者 (≥80岁) 在急性缺血性中风 (AIS) 的内血管血栓切除 (EVT) 试验中代表性不足,大血管封闭 (LVO) 和低阿尔伯塔中风计划早期CT评分 (ASPECTS ≤5).
关于EVT在特定老年人群中的有效性和安全性的数据有限.

研究的目的:

评估老年患者 (≥80岁) 的EVT结果,这些患者患有LVO-AIS和低ASPECTS (≤5).
在这个患者群体中确定有利结果和死亡率的预测因素.

主要方法:

分析了来自37个血栓切除中心 (2013-2023) 的前性维护数据.
包括80岁以上的LVO-AIS和ASPECT ≤5接受EVT的患者.
主要结局:90天后有利的修改的兰金尺度 (mRS) 评分 (0-3).
统计分析包括倾向性得分匹配 (PSM) 和多变量回归.

主要成果:

在14233名EVT患者中,1741人年龄≥80岁,122人ASPECTS≤5.5.
虽然再通道化率相似,但老年患者在PSM前的mRS和死亡率较低.
在PSM后,死亡率和症状性内出血 (sICH) 的差异并不显著.
更高的ASPECTS预测了老年患者的良好结果,但不是死亡率.
对于低ASPECTS的老年患者,有利的结果与较低的心房率,更好的基线功能,更少的通过和更快的再输血有关.

结论:

80岁以上的年龄与AIS患者的死亡率和残疾增加有关,ASPECTS.
选择患有AIS和低ASPECTS的老年患者仍然可能从EVT中受益.
个性化治疗和仔细的患者选择对于优化老年人EVT结果至关重要.

关键词:

动脉动脉的动脉是一个动脉.导管导管是一种导管导管.一次性中风,中风.进行血栓切除术 (thrombectomy).

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