血管内血栓切除术后的一年后的结果,以轻微缺陷的基底动脉封闭为原因
Yingjie Xu1, Lulu Xiao2, Pan Zhang1
1Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China (Y.X., P.Z., Z.L., X.Z., W.Z., X.L., W. Sun).
Stroke
|April 25, 2025
概括
血管内血栓切除术 (EVT) 没有显示出与单独最佳医疗管理 (BMM) 相比,对基底动脉封闭 (BAO) 患者具有NIH中风评分较低的患者有显著的长期益处. 早期的EVT优于晚期的EVT,但与单独的BMM没有显著差异.
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:
- 基底动脉封闭 (BAO) 带来重大风险,并且内血管血栓切除术 (EVT) 在轻度中风症状 (NIH中风量表得分低) 的患者的长期疗效尚未得到充分证实.
- 目前的治疗指南通常只建议在这种情况下进行最佳医疗管理 (BMM),但添加EVT的比较好处需要进一步调查.
研究的目的:
- 为了比较单独的BMM和BMM加EVT在BAO患者和低入院NIH中风量级分数 (≤10) 的1年功能结果和死亡率.
- 评估治疗时间 (Early vs. Late EVT) 对患者结局的影响.
主要方法:
- 一项回顾性研究涉及1232名患者,在中国65个中心 (2015年12月 - 2022年6月) 的BAO和NIH中风量级得分≤10.
- 患者被分为单独的BMM和BMM加EVT组,EVT进一步被分为早期 (≤120分钟) 或晚 (>120分钟) 的门到穿孔时间.
- 统计分析包括多变量后勤回归和倾向得分匹配来评估结果,主要结果是有利的功能结果 (修改的兰金表得分0-3在1年).
主要成果:
- 在EVT和BMM组之间没有发现1年后有利的功能结果的显著差异 (OR,0.96;95% CI,0.71-1.29;P=0.778).
- 一年死亡率在各组之间是相似的 (16.4%的EVT对比13.7%的BMM;OR,1.23;95%CI,0.86-1.77;P=0.262).
- 亚组分析表明,早期EVT与晚期EVT (OR,0.47;95%CI,0.28-0.79;P=0.005) 相比,与更好的结果有关,而早期EVT与单独BMM相比没有显著差异 (OR,0.87;95%CI,0.63-1.21;P=0.421).
结论:
- 对于BAO和NIH中风评分较低的患者,EVT与1年内单独的BMM相比,没有显著的长期功能或生存益处.
- 治疗时间至关重要,早期的EVT与晚期的EVT相比,表现优越,尽管并不明显优于单独的BMM.
- 这些发现表明,对于轻度BAO呈现,需要仔细考虑EVT时间和患者选择.
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