大血管闭塞中风的NIHSS得分较低:最佳治疗和临床争议
Tonghe Chen1,2, Wenhong Zhi1,2, Ning Hao1,2
1Department of Neurology, XuZhou Clinical School of XuZhou Medical University, Xuzhou, Jiangsu, China.
Frontiers in neurology
|November 26, 2025
概括
对于急性缺血性中风,大血管封闭和NIHSS分数低,内血管血栓切除没有显著的功能性结局效益比医学治疗. EVT可能会增加出血风险,建议根据阻塞部位和恶化风险进行个性化治疗.
科学领域:
- 神经学 神经学
- 干预神经病学 干预神经病学
- 脑卒中医学 脑卒中医学
背景情况:
- 大血管封闭 (LVO) 急性缺血性中风,NIHSS得分低,带来管理挑战.
- 内血管血栓切除术 (EVT) 是中度至重度中风的标准,但其在轻度病例中的益处仍在争论中.
- 在低NIHSS中风患者中,平衡EVT的益处与内出血等风险至关重要.
研究的目的:
- 审查和综合关于EVT与低NIHSS分数LVO中风的最佳医疗疗疗法的证据.
- 评估该患者群体中的功能结果,安全性和亚组差异.
- 为临床决策提供信息,并确定未来研究的需求.
主要方法:
- 对观察性研究和注册数据进行系统审查和元分析.
- 将EVT与最佳治疗方法 (IV血栓溶解,抗血小板药物) 的比较.
- 基于闭塞位置,神经系统恶化风险和时间窗口的子组分析.
主要成果:
- 在EVT和医疗管理之间,90天的功能结果没有显著差异.
- 在观察数据中,EVT与较高的症状内出血 (sICH) 和潜在的死亡率增加有关.
- 靠近性闭塞和高早期神经恶化 (END) 风险可能有利于EVT;远端闭塞通常通过医疗来管理.
结论:
- 对于大多数LVO中风患者,NIHSS得分较低的患者,建议进行医疗管理.
- EVT应保留给高风险病例或经历神经系统恶化的人.
- 需要进一步的随机试验来完善患者选择和风险分层.
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