由于中等血管封闭而导致的中风的内血管治疗
Mayank Goyal1,2, Johanna M Ospel1,2, Aravind Ganesh2
1Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
The New England journal of medicine
|February 5, 2025
概括
与常规护理相比,内血管血栓切除术 (EVT) 并没有改善中血管封闭性中风的结果. 这项研究发现,EVT对患有中血管封闭引起的急性缺血性中风的患者没有显著的益处.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 血管外科 血管外科
背景情况:
- 内血管血栓切除术 (EVT) 在大血管封闭 (LVO) 缺血性中风方面显示出显著的益处.
- 对于中等血管封闭性中风 (MeVO) 的EVT的疗效仍然不确定.
- 研究EVT在MeVO中的有效性对于扩大中风治疗指南至关重要.
研究的目的:
- 为了确定EVT是否改善了急性缺血性中风患者的功能结果,而中血管封闭引起的原因.
- 为了在这个患者群体中比较EVT加常规护理的疗效和安全性,与单独的常规护理相比.
- 评估EVT对90天修改的兰金度数和死亡率的影响.
主要方法:
- 一个多中心,前性,随机化,开放标签试验与盲目的结果评估 (ESCAPE-MeVO).
- 由于MeVO而导致急性缺血性中风的患者,在上次已知的时间12小时内,并随机进行了有利的成像.
- 干预组:EVT加常规护理与单独的常规护理. 主要结局:90天后修改的兰金度数得分 (0-1).
主要成果:
- 招募了530名患者;255人接受了EVT,275人接受了通常的护理.
- 两组之间功能性结果没有显著差异 (90天的mRS 0-1) (41.6%的EVT与43.1%的常规护理;率比0.95,P=0.61).
- 与常规护理 (8.4%) 相比,EVT组 (13.3%) 的死亡率更高. 在EVT组中增加了症状性内出血 (5.4%对2.2%).
结论:
- 由于中血管封闭导致的急性缺血性中风的内血管治疗在12小时内没有导致90天后的功能结果比通常护理更好.
- 在这种情况下,EVT与死亡率增加和症状性内出血有关.
- 目前的证据不支持在急性缺血性中风中常规使用EVT,原因是中血管封闭.
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