在患有大血管阻塞,不同机制的中风患者的内血管治疗
Zhiyuan Feng1,2, Ming Yang2,3, Aoming Jin2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 S Fourth Ring W Rd, Fengtai District, Beijing, 100070, China.
Neurology and therapy
|March 29, 2025
概括
大血管封闭性急性缺血性中风 (AIS-LVO) 的结果在 in situ 血栓形成 (IST),动脉对动脉栓塞 (AAE) 和心血管栓塞 (CE) 机制之间是相似的. 症状性内出血在AAE中较高,但没有任何机制预测功能结果.
科学领域:
- 神经学 神经学
- 干预性神经放射学 干预性神经放射学
- 血管医学 血管医学
背景情况:
- 患有大血管闭塞的急性缺血性中风 (AIS-LVO) 有不同的病因,包括现场血栓 (IST),动脉对动脉栓塞 (AAE) 和心血管栓塞 (CE).
- 关于与每个AIS-LVO机制相关的不同临床概况和预后的现实数据仍然有限.
研究的目的:
- 为了比较AIS-LVO的三个主要机制中的临床特征,实验室发现,内血管治疗 (EVT) 程序因素和患者预后.
- 确定在接受EVT的AIS-LVO患者中功能性结局的预测因素.
主要方法:
- 对162名在2023年4月至2024年8月期间接受EVT的AIS-LVO患者的回顾性分析.
- 将患者分为IST,AAE或CE组进行分类.
- 主要结局:3个月后修改的兰金度量 (mRS) 评分,通过顺序逻辑回归分析.
主要成果:
- 现场血栓形成 (IST) 是最常见的机制 (n=81),其次是心血管栓塞 (CE) (n=41) 和动脉对动脉栓塞 (AAE) (n=40).
- 脑脊髓炎患者表现出更严重的症状和更高的脑内出血率. IST与更快的进展和后部循环干扰有关. AAE患者的手术时间更长,症状性内出血 (sICH) 率更高.
- 两组之间没有观察到重新道化率或功能结果 (mRS分布,3个月后的良好结果) 的显著差异,但在CE组中发现了更好的结果的趋势. 年龄,EVT前NIHSS和sICH独立预测了有利的结果.
结论:
- 对于AIS-LVO患者的功能结果在IST,AAE和CE机制之间是可比的,尽管临床表现和并发症率存在差异 (例如,AAE中SICH更高).
- 在这个队列中,AIS-LVO的潜在机制并没有成为功能结果的预测因素.
- 需要进一步的研究来确定最佳的管理策略,以适应AIS-LVO的具体机制.
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