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针对与孤立的脊椎动脉阻塞 (BRAVO) 相关的中风的重血管化方法的结果和安全性

Alexander Salerno¹, Vincent Dunet², Marek Sykora³

¹Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland (A.S., D.S., P. Michel).

|March 10, 2026

概括

只有静脉内血栓溶解 (IVT) 对于来自单独的脊椎动脉封闭的急性缺血性中风是安全的,可以改善早期恢复. 内血管治疗 (EVT) 显示出更糟糕的结果,但可能有利于严重的中风.

科学领域:

神经学神经学
血管医学血管医学
干预心脏病学干预心脏病学

背景情况:

由于单独的脊椎动脉封闭引起的急性缺血性中风的最佳再血管化策略尚未确立.
脊椎动脉堵塞是缺血性中风的不常见但严重的原因.

研究的目的:

为了比较不同重血管化策略的有效性和安全性,针对由于孤立的脊椎动脉封闭而导致的急性缺血性中风.
为了评估仅静脉血栓溶解 (IVT),内血管治疗 (EVT) ±IVT以及保守治疗 (Cx).

主要方法:

追溯性,国际,多中心队列研究 (2016-2022),包括494名患者.
仅IVT与Cx的比较,以及EVT±IVT与医疗管理 (MM) 的比较.
主要结局:3个月修改的兰金度量 (mRS) 评分转移;次要结局包括早期的神经改善,再通道化和并发症. 使用治疗权重的逆概率 (IPTW) 调整的分析.

主要成果:

仅IVT显示与Cx相比,类似的mRS转移,但改善了早期的神经改善和再通道化率.
与MM相比,EVT±IVT与更糟糕的mRS转移,更高的早期神经系统恶化率和症状性脑内出血有关.
使用EVT±IVT时,再通道化率明显高于EVT±IVT,并且这种治疗可能有利于国家卫生研究院中风量表得分≥10.0的患者.

结论:

仅IVT是一种安全的选择,与较好的早期康复和急性缺血性中风中隔离脊椎动脉阻塞的再通道相关.
EVT±IVT总体表现较差,可能是由于早期神经系统恶化和出血增加,但在中度至严重的中风病例中需要进一步调查.
需要进行前性试验,以确认EVT在特定小组患者的潜在益处,这些患者有症状的隔离脊椎动脉封闭.

关键词:

大脑动脉疾病大脑动脉疾病脑血管疾病脑血管疾病进行保守的治疗.缺血性中风中风进行血栓切除术 (thrombectomy).血栓溶解药物治疗的方法脊椎动脉脊椎动脉脊椎动脉

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