机械血栓切除和压缩性脑膜切除急性缺血性中风的趋势:全国性的分析
Lucinda T Chiu1, Ethan Ritz2, Krishna Joshi1
1Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
概括
针对急性缺血性中风 (AIS) 的机械血栓切除术 (MT) 从2012年至2020年显著增加,而解压性脑膜切除术 (DHC) 则减少. 这些中风治疗方法现在在较小的医院更容易获得,并接触到更老,更生病的患者.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 公共卫生 公共卫生
背景情况:
- 对于急性缺血性中风 (AIS) 的内血管治疗和解压性脑膜切除术 (DHC) 的适应症已经发展.
- 延长时间机械血栓切除术 (MT) 试验的发表影响了治疗趋势.
研究的目的:
- 分析机械血栓切除术 (MT) 和DHC率的趋势.
- 评估扩展的MT资格试验对治疗模式的影响.
主要方法:
- 国家住院患者样本数据库 (2012-2020年) 的回顾性分析.
- 包括美国成年人 (≥18岁) 患有大血管,近道前部循环AIS,接受手术干预.
- 基于MT试验时代的子组分析:血栓切除前 (2012-2014),血栓切除 (2015-2017),以及扩展的血栓切除 (2018-2020).
主要成果:
- AIS住院病例从329,398人增加到359,242人 (2012-2020年).
- MT率从0.94% (2012-2014) 升至3.2% (2018-2020),而DHC率则从0.4%降至0.2%. 在此期间,MT率从0.94% (2012-2014) 升至3.2% (2018-2020),而DHC率从0.4%降至0.2%.
- MT和DHC程序分散到中小型医院; MT越来越多地在农村环境中进行. MT扩展到老年人 (>81岁) 和更重病患者.
结论:
- 自2012年以来,全国MT发病率上升,而DHC则下降.
- 扩展的MT资格试验对观察到的趋势的影响有限.
- 手术中风治疗已经分散,MT和DHC更频繁地在较小的设施中进行,MT更频繁地到达更老,更生病的AIS患者.
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