导航远端血管:从失败的血栓切除试验中获得的挑战和经验教训
Peter B Sporns1,2,3, Mohammad Almohammad4, Jens Minnerup5
1Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
概括
对于远端中血管封闭 (DMVOs) 的内血管血栓切除术 (EVT) 在最近的试验中没有显示出与标准护理相比的好处. 安全问题和技术挑战限制了DMVO中风的常规EVT.
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
- 脑卒中医学 脑卒中医学
背景情况:
- 内血管血栓切除术 (EVT) 是大型血管闭塞中风的标准.
- 最近的试验 (DISTAL,ESCAPE-MeVO,DISCOUNT) 在将EVT扩展到远端中等血管封闭 (DMVO) 方面取得了中立的结果.
研究的目的:
- 在DMVO试验中批判性地检查EVT缺乏益处.
- 评估远程干预过程中的程序和临床挑战.
- 探索治疗远端脑血管闭塞的未来方向.
主要方法:
- 从最近的DMVO血栓切除试验中综合发现.
- 具有解剖学,技术和临床限制的上下文化结果.
- 突出了远程EVT设备和技术的创新.
主要成果:
- 对于未被选择的DMVO患者来说,EVT对最佳医疗疗法没有功能上的好处.
- 在EVT手臂中增加了症状性内出血和死亡率.
- 促成因素:脆弱/折的容器,设备问题,操作员的变化,成像/选择限制.
结论:
- 根据目前的证据,不建议对DMVO中风进行常规EVT.
- 未来的研究需要患者分层,专用远端设备和程序创新.
- 在偏远地区安全有效的治疗需要进一步发展.
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