血栓溶解后出现的内支架的安全性:一个多中心匹配分析
Andrea M Alexandre1, Luca Scarcia1, Arturo Consoli1
1From the Interventional Neuroradiology Unit (A.M.A., A.P.) and Neurology Unit (A.B.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy; Department of Neuroradiology (L.S.), Henri Mondor Hospital, Creteil, France; Department of Diagnostic and Therapeutic Neuroradiology (A.C., A.S.), Hôpital Foch, Suresnes, France; Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, (W.S., Y.H), The First Affiliated Hospital of USTC, Hefei, Anhui, China; Department of Neurology (X.H.), Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China; Department of Neurosurgery and Department of Radiology (C.C., E.R.), NYU Langone Health, New York, NY, USA; Department of Radiology and Neurology (M.A., T.N.N.), Boston Medical Center, Boston, MA, USA; Interventional Neurovascular Unit (N.L.), A.O.U. Careggi, Firenze, Italy; Neuroradiology Unit (D.D.L.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Neuroradiology Unit (M.P.G.), Presidio Ospedaliero Centrale SS Annunziata, Taranto, Italy; Department of Neuroradiology (C.G.), Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy; Neuroradiology Unit (R.R.), Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy; Department of Radiology (C.P.), Rouen University Hospital, Rouen, France; Neuroradiology Unit (R.P.), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Interventional Neuroradiology (N.M.), Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Neuroradiology Unit (J.D.G.), Padua University Hospital, Padua, Italy; Interventional Neuroradiology Unit (P.P.), IRCCS San Raffaele University Hospital, Milan, Italy; Department of Neurology and Stroke Center (A.Z.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy; Department of Interventional Neuroradiology (F.C.), Pitié-Salpêtrière University Hospital, Paris, France; Department of Neuroscience (A.B.), Catholic University School of Medicine, Rome, Italy.
内静脉血栓溶解 (IVT) 并没有显著影响救援支架 (RS) 的安全性,因为大血管封闭 (LVO) 与内动脉狭窄 (ICAS). 这项研究发现,在RS之前进行IVT之前,没有增加出血或死亡风险.
科学领域:
- 神经学 神经学
- 干预性神经辐射学
- 脑卒中医学 脑卒中医学
背景情况:
- 中脑动脉中急性大血管封闭 (LVO) 与内动脉狭窄 (ICAS) 往往需要机械血栓切除术 (MT).
- 救援支架 (RS) 已经显示出比单独的MT更好的结果,但仍然存在关于出血风险的安全担忧.
- 之前的静脉血栓溶解 (IVT) 对这些患者RS安全性的影响尚不清楚.
研究的目的:
- 为了比较急性MCAICAS-LVO患者RS的安全结果,这些患者先前接受了IVT,而不是那些没有接受IVT的患者.
- 作为次要目标,评估疗效结果,包括再通道化和功能独立.
主要方法:
- 一项回顾性多中心研究分析了26个中风中心的数据.
- 对急性MCAICAS-LVO进行RS的患者被分为IVT/RS和非IVT/RS组.
- 倾向分数匹配 (PSM) 用于控制混因素,包括抗血小板疗法,以评估IVT的影响.
主要成果:
- 在PSM之后,分析了52对患者. 在IVT/RS和无IVT/RS组之间,在症状性内出血 (sICH) 率 (11.5%对9.6%) 或90天死亡率 (14.3%对11.7%) 中没有发现显著差异.
- 没有观察到围膜出血类型,成功的再通道化率或90天功能结果的显著差异.
- 该研究表明,在此患者队列中,先前IVT的使用不会显著改变RS的安全性或疗效.
结论:
- 对于急性大血管封闭 (LVO) 与内动脉狭窄 (ICAS) 的救援支架 (RS) 似乎是安全的,无论先前的静脉血栓溶解 (IVT) 管理.
- 在RS之前使用时,IVT似乎没有改善再通道或临床结果.
- 这些发现需要通过未来的随机对照试验来验证.
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