大型核心试验:实践现状
Gianluca De Rubeis1, Sebastiano Fabiano1, Luca Bertaccini1
1Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome (GDR, SF, LB, EP); Emergency Department, UOSD Stroke Unit, S. Camillo-Forlanini Hospital, Rome, Italy (FRP) Stroke Unit, Santa Maria della Misericordia hospital, University of Perugia (VC) Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari (LS).
大核心中风试验显示机械血栓切除有好处,但ASPECT得分限制可能会影响结果. 输液成像在评估中风患者的缺血核心和可挽救组织方面优于ASPECT得分.
科学领域:
- 神经学 神经学
- 干预神经病学 干预神经病学
- 脑卒中医学 脑卒中医学
背景情况:
- 最近的大型核心随机对照试验 (RCT) 评估了急性缺血性中风的机械血栓切除术.
- 六个RCT表明,在ASPECTS分数低的患者中,血栓切除术优于医疗治疗.
- 使用ASPECTS (10分级) 来定义缺血核心具有局限性,特别是对于超出中脑动脉 (MCA) 区域的变化.
研究的目的:
- 批判性地分析最近关于大型核心RCT的出版物.
- 评估使用ASPECTS来定义缺血核心对这些试验的外部有效性的影响.
- 为了比较ASPECTS与 perfusion成像在评估心脏病核心和可挽救的大脑组织中的可靠性.
主要方法:
- 通过检查阻塞位置,附带血流和输液成像来评估ASPECTS的可靠性.
- 对HERMES合作与六个大型核心RCT的数据进行了比较.
- 研究了闭塞部位对心脏病发作大小和可挽救的大脑组织的影响.
主要成果:
- 与HERMES协作相比,RCT在大型核心试验中显示出更多近端闭塞的趋势.
- ASPECTS在近端MCA遮蔽之外的缺血变化没有充分描绘,可能导致误解.
- 输液成像识别了核心体积和可挽救区域,比单独的ASPECTS更准确.
结论:
- 在大型核心中风RCT中,输液成像在评估心脏病核心和可挽救组织方面优于ASPECTS.
- 建议在大型核心RCT中重新定义心脏病核心评估,优先考虑输液成像而不是ASPECTS.
- 需要进一步的研究来完善血栓切除术的成像标准,考虑到阻塞部位的意义.
更多相关视频
00:04A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
09:52Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
相关概念视频
Clinical Trials: Overview
Clinical Trials
There are four phases in a clinical trial. A phase one...
Standards of Care II
Study Design in Statistics
Does aspirin reduce the risk of heart attacks? Is one brand of fertilizer more effective at growing roses than another? Is fatigue as dangerous to a driver as the influence of alcohol? Questions like these are answered using randomized experiments with proper...
Study Designs in Epidemiology
Observational studies are those where the researcher does not intervene but rather observes natural variations. They include cross-sectional, cohort, and...
Standards of Care I
