在急性缺血性中风的血栓切除术期间,救援与第一线内支架:对 RESISTANT 注册表的倾向权衡分析
Aaron Rodriguez-Calienes1, Dileep R Yavagal2, Negar Asdaghi2
1Department of Neurology, University of Iowa Hospitals and Clinics, UNITED STATES.
Stroke
|January 29, 2026
概括
第一线支架 (FLS) 和救援支架 (RS) 在急性缺血性中风中具有可比的安全性和有效性,通过内血管血栓切除术 (EVT) 治疗大血管封闭. 需要进一步的随机试验来确认最佳的支架策略.
科学领域:
- 神经学 神经学
- 干预性神经辐射学
- 血管外科 血管外科
背景情况:
- 救援支架 (RS) 是急性缺血性中风与大血管封闭 (AIS-LVO) 失败的内血管血栓切除术 (EVT) 的标准救助方案.
- 第一线支架 (FLS) 是一种新兴的替代方案,旨在减少血管损伤并改善结果.
- 在AIS-LVO中,FLS与RS的直接比较数据有限.
研究的目的:
- 为了比较FLS与RS在接受AIS-LVOEVT的患者中的安全性和有效性.
- 分析两个支架策略之间的功能独立性和症状性内出血率.
主要方法:
- 多中心,国际RESISTANT注册 (2016-2023) 的回顾性分析,包括827名AIS患者在EVT期间接受内支架治疗.
- 患者被分为FLS (在血栓切除术前放置的支架) 和RS (在血栓切除术失败后放置的支架) 两组.
- 倾向性得分是治疗权重的逆概率 (IPTW),以基线差异进行调整,以比较结果.
主要成果:
- 在FLS和RS (OR=0.64;95%CI 0.38-1.07) 之间的功能独立性 (90天的mRS 0-2) 中没有发现显著差异.
- 症状性内出血 (sICH) 的发生率在FLS和RS之间也相当 (OR=0.93;95% CI 0.34-2.59).
- 二次结果,包括再输血,死亡率和程序并发症,在前后循环队伍中没有显著差异.
结论:
- 目前的数据表明,FLS和RS在AIS-LVO中对EVT具有相似的安全性和有效性.
- 根据该注册数据,FLS和RS之间的选择可能不会显著影响患者的治疗结果.
- 未来的随机对照试验对于最终确定AIS-LVO治疗最佳支架策略至关重要.
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