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转关节动脉支架后手术后中风的预测因素

Elisa Caron¹, Sai Divya Yadavalli², Jeremy Darling²

¹Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Vascular and Endovascular Surgery, Boston Medical Center- Brighton, Boston University School of Medicine, Boston, MA.

Journal of vascular surgery

|June 26, 2025

概括

失控的高血压,突发性手术和严重的远端扭曲是转性大脑动脉支架 (tfCAS) 后中风的关键预测因素. 管理可修改的风险因素和考虑患者解剖学可以改善tfCAS程序的结果.

科学领域:

血管外科血管外科
干预心脏病学干预心脏病学
神经外科神经外科

背景情况:

医疗保险和医疗补助服务中心在2023年扩大了转关节动脉支架 (tfCAS) 的覆盖范围,以覆盖标准风险患者.
确定术后中风的预测因子对于优化患者选择和改善tfCAS后的结果至关重要.

研究的目的:

确定在经过转关节动脉支架 (tfCAS) 的患者在医院内术后中风的预测因素.
开发一个术后中风风险预测系统,以后的tfCAS.

主要方法:

2011年至2024年血管质量倡议数据的分析,包括35,346起tfCAS病例.
基于医院内术后中风状态的患者分层.
后勤回归和10倍交叉验证以确定中风预测因素并开发风险预测点系统.

主要成果:

整体住院中风率为2% (693/35,346名患者).
增加中风风险的预测因素包括不受控制的高血压,新出现的手术,严重的远端形,年龄超过75岁,手术前的中风,先前的动脉内关节切除术,III型门和化.
双重抗血小板治疗和高体积操作员/中心与降低中风几率有关. 一个预测点系统的AUC达到0.68.68.

结论:

已识别的中风风险因素可以提高患者对tfCAS的选择.
术前对可修改因素 (高血压,抗血小板治疗) 的治疗以及仔细考虑手术时间是很重要的.
形,形类型和化等解剖学因素需要考虑替代的再生血管化策略.

关键词:

冠状动脉狭窄症冠状动脉狭窄预测中风风险的预测因素分享决策的共同决策一次性中风,中风.在tfCASCAS中使用.

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