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Prevalence of small vessel disease and incidental DWI-positive lesions in patients with aneurysmal subarachnoid hemorrhage versus intracerebral hemorrhage. 动脉瘤性蛛网膜下腔出血与脑出血患者小血管疾病和附带 DWI 阳性病灶的患病率。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-19 DOI: 10.1177/23969873241232327
Zi-Jie Wang, Xiao Hu, Yan-Fang Xie, Wen-Jun Yao, Lan Deng, Zuo-Qiao Li, Ming-Jun Pu, Xin-Ni Lv, Zi-Cheng Hu, Jiang-Tao Zhang, Qi Li

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse.

Patients and methods: We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated.

Results: We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, p < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH.

Discussion and conclusion: Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.

导言:动脉瘤性蛛网膜下腔出血(aSAH)和脑内出血(ICH)是出血性卒中的主要形式。有关蛛网膜下腔出血后脑小血管疾病(SVD)负担和弥散加权成像(DWI)中偶然出现的小病灶的数据非常稀少:我们对2015年3月至2023年1月期间发病后30天内进行脑磁共振成像的前瞻性队列中的aSAH和ICH患者进行了回顾性分析。我们评估了白质高密度(WMH)、裂隙、血管周围间隙、脑微出血(CMB)、SVD 总分和附带 DWI 病变,并对 aSAH 和 ICH 进行了比较。结果:我们共纳入了180例ASAH患者:我们纳入了 180 名 aSAH 患者(中位年龄 [IQR] 53 [47-61] 岁)和 299 名 ICH 患者(63 [53-73] 岁)。与 ICH 相比,DWI 病变在 aSAH 中更为常见(47.8% 对 14.4%,P 讨论和结论:aSAH 与 ICH 相比,偶发 DWI 病变和严格意义上的叶状 CMB 更为常见,而 ICH 的 SVD 负荷更高。aSAH 中的偶发 DWI 病变与多种临床和影像学因素有关。似乎有必要进行纵向研究,以探讨隐匿性出血性和缺血性病变在 aSAH 中的动态变化和预后价值。
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引用次数: 0
Searching for biomarkers of atrial cardiomyopathy at high risk of cardioembolism: What are the missing pieces of the puzzle? 寻找心房栓塞高风险心肌病的生物标志物:拼图中缺失的部分是什么?
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-30 DOI: 10.1177/23969873241276357
Maurizio Acampa, Pietro Enea Lazzerini
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引用次数: 0
Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial. ARCADIA 试验中的心房心脏病生物标志物和心房颤动。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-30 DOI: 10.1177/23969873241276358
Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell

Background: ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.

Methods: Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V1 (PTFV1), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m2. For this analysis, the outcome was AF detected per routine care.

Results: Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.

Conclusions: Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.

背景ARCADIA 比较了阿哌沙班和阿司匹林对隐源性卒中和心房性心脏病患者进行卒中二级预防的效果。中性结果的一个可能原因是所使用的生物标志物不能最佳地识别心房性心脏病。我们研究了生物标志物水平与随后发现房颤(心房颤动的标志)之间的关系:如果患者符合心房性心脏病的标准,即心电图 V1 导联(PTFV1)P 波终末力>5000 μV*ms、NT-proBNP>250 pg/mL,或左心房直径指数(LADI)⩾3 cm/m2,则对其进行随机分组。本次分析的结果是在常规护理中发现房颤:在 3745 名同意接受心房病变筛查的患者中,有 254 人随后被确诊为房颤;其中 96 人在接受随机化之前,158 人在接受随机化之后。在未经调整的分析中,ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13)、PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28)和 LADI (RR per SD, 1.34; 95% CI, 1.20-1.50)与房颤相关。在包含所有三种生物标志物、人口统计学特征和房颤风险因素的模型中,年龄(每 10 年的 RR 值为 1.24;95% CI 为 1.09-1.41)、ln(NT-proBNP)(每 SD 的 RR 值为 1.88;95% CI 为 1.67-2.11)和 LADI(每 SD 的 RR 值为 1.25;95% CI 为 1.14-1.37)与房颤相关。这三个变量加在一起的 c 统计量为 0.82(95% CI,0.79-0.85),但校准度不高。在对符合随机化条件的患者进行的敏感性分析中,对房颤进行更密切随访的识别率有所降低:结论:在 ARCADIA 中用于识别房颤的生物标志物对后续房颤有一定的预测作用。
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引用次数: 0
Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia. 直接口服抗凝剂和华法林在心房颤动伴痴呆患者中的有效性和安全性比较。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-30 DOI: 10.1177/23969873241274598
Chen-Wen Fang, Cheng-Yang Hsieh, Hsin-Yi Yang, Ching-Fang Tsai, Sheng-Feng Sung

Introduction: Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.

Patients and methods: We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.

Results: There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.

Discussion and conclusion: Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.

导言:制定有效的中风预防策略对于老年心房颤动 (AF) 痴呆患者至关重要。这是因为这方面的证据有限且不一致。在这项基于人群的全国性队列研究中,我们旨在比较直接口服抗凝药(DOACs)和华法林对老年痴呆房颤患者的有效性和安全性:我们从 2010 年至 2019 年期间的台湾国民健康保险研究数据库中识别了 50 岁或以上的房颤痴呆患者。主要结果是缺血性中风、急性心肌梗死、颅内出血或大出血导致的住院治疗以及全因死亡率的复合结果。在比较华法林和DOAC(阿哌沙班、达比加群、依度沙班或利伐沙班)使用者之间或华法林和每种DOAC使用者之间的结果时,我们使用了1:1倾向得分匹配和Cox比例危险模型来调整混杂因素:DOAC与华法林匹配队列中有2952名患者。阿哌沙班、达比加群、依度沙班和利伐沙班-华法林匹配队列分别有 2346、2554、1684 和 2938 名患者。与华法林相比,DOAC组发生复合结局(危险比(HR)0.81;95% 置信区间(CI)0.69-0.95)和缺血性卒中(HR 0.65;95% CI 0.48-0.87)的风险较低。阿哌沙班(HR 0.79;95% CI 0.66-0.94)、达比加群(HR 0.64;95% CI 0.53-0.77)和利伐沙班(HR 0.82;95% CI 0.70-0.97)也与较低的综合结果风险相关:与华法林相比,DOACs(无论是作为一组药物还是阿哌沙班、达比加群或利伐沙班单独使用)与并发房颤和痴呆的老年患者的综合结局风险降低相关。
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引用次数: 0
Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure. 在大血管闭塞的机械血栓切除术中,血流恢复与全身血压的即时降低有关。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-30 DOI: 10.1177/23969873241274512
Anna Andriana Kyselyova, Caspar Brekenfeld, Lucas Meyer, Helena Guerreiro, Gabriel Broocks, Susan Klapproth, Tobias Faizy, Christian Heitkamp, Malte Issleib, Jens Fiehler, Fabian Flottmann

Introduction: Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.

Patients and methods: Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.

Results: Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant.

Discussion and conclusions: Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.

导言:大血管闭塞患者的血压管理会影响梗死面积和临床预后。我们研究了在机械血栓切除术中恢复血流如何影响全身血压:筛选了 2016 年 6 月至 2018 年 1 月间接受机械血栓切除术的前循环大血管闭塞患者。我们纳入了在局部麻醉或有意识镇静下接受治疗的患者,并分析了标准化麻醉方案,以评估整个手术过程中的收缩压和舒张压水平。主要结果是血压的变化,比较最后一次再灌注尝试前 5 分钟和尝试后 5 分钟的血压变化。脑梗塞溶栓评分⩾ 2b 定义为再灌注成功:134例患者中,117例(87%)血管再灌注成功,血流恢复后5分钟收缩压明显下降(10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg,p = 0.009)。在多变量逻辑回归中,血管再灌注成功是导致血压下降的重要预测因素:OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299)。在 66 名未服用影响循环药物的患者中,也观察到收缩压显著降低(从 155 ± 17 mm Hg 降至 148 ± 17 mm Hg;p 讨论和结论:在局部麻醉或有意识镇静状态下接受机械再通术的患者,血流恢复与收缩压值的立即降低有关。这表明血管内卒中治疗与心血管血流动力学之间存在复杂的相互作用。
{"title":"Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.","authors":"Anna Andriana Kyselyova, Caspar Brekenfeld, Lucas Meyer, Helena Guerreiro, Gabriel Broocks, Susan Klapproth, Tobias Faizy, Christian Heitkamp, Malte Issleib, Jens Fiehler, Fabian Flottmann","doi":"10.1177/23969873241274512","DOIUrl":"10.1177/23969873241274512","url":null,"abstract":"<p><strong>Introduction: </strong>Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.</p><p><strong>Patients and methods: </strong>Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.</p><p><strong>Results: </strong>Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, <i>p</i> = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, <i>p</i> = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; <i>p</i> < 0.001). No diastolic pressure changes were significant.</p><p><strong>Discussion and conclusions: </strong>Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241274512"},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review. 中风或 TIA 患者的信息需求及其接受健康信息的首选方式:范围综述。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-26 DOI: 10.1177/23969873241272744
Jasmin Helbach, Falk Hoffmann, Nina Hecht, Christoph Heesen, Götz Thomalla, Denise Wilfling, Anne Christin Rahn

Purpose: We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention.

Methods: In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews.

Findings: We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early.

Conclusion: PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.

目的:我们旨在综述脑卒中患者(PwS)在预防复发性脑卒中方面的信息需求:在此次范围界定综述中,我们检索了 Medline(通过 PubMed)、CINAHL 和 PsycINFO 从开始到 2023 年 6 月 5 日的所有研究,以确定所有描述在过去 5 年中遭受过中风或短暂性脑缺血发作的 18 岁及以上人群信息需求的研究。我们纳入了发达国家以德语或英语发表的定性和定量研究。数据分析按照 Arksey 和 O'Malley 的范围界定综述方法框架进行:我们筛选了 5822 条符合条件的记录,并纳入了在 1993 年至 2023 年间发表的 36 篇文章。所纳入的研究均未使用综合框架或定义信息需求。根据卒中患者及其照护者的陈述,卒中患者需要的信息包括治疗、病因、卒中的影响、预后、康复、出院、生活变化、照护角色、支持选择、信息来源以及住院程序。最常表达的需求是治疗信息(77.8%)和中风病因信息(63.9%)。主要的信息来源是医护人员(85.7%),其次是书面信息(71.4%)、家人和朋友 (42.6%)以及互联网(35.7%),其中医护人员直接提供的信息更受欢迎。信息传递的时间通常被描述为过早:结论:患者主要对有关中风的临床信息感兴趣,如治疗和病因,而对日常生活信息较 少感兴趣,如康复、护理的作用或生活方式的改变。他们更愿意直接从医护人员那里获取信息。要在临床实践中实施适当的策略和计划来满足这些需求,对患者的信息需求达成共识是至 关重要的。
{"title":"Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review.","authors":"Jasmin Helbach, Falk Hoffmann, Nina Hecht, Christoph Heesen, Götz Thomalla, Denise Wilfling, Anne Christin Rahn","doi":"10.1177/23969873241272744","DOIUrl":"10.1177/23969873241272744","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention.</p><p><strong>Methods: </strong>In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews.</p><p><strong>Findings: </strong>We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early.</p><p><strong>Conclusion: </strong>PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272744"},"PeriodicalIF":5.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medical complications during interhospital transfer for thrombectomy in patients with acute ischemic stroke. 急性缺血性脑卒中患者院间转运血栓切除术期间的医疗并发症。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-26 DOI: 10.1177/23969873241272507
Damjan Mirkov, Ekkehart Jenetzky, Andrea S Thieme, Adeeb Qabalan, Christoph Gumbinger, Wolfgang Wick, Peter A Ringleb, Timolaos Rizos

Introduction: Patients with acute ischemic stroke (AIS) and large-vessel occlusion are frequently transferred by emergency physicians (EPs) from primary to comprehensive stroke centers (CSC) for thrombectomy, particular when thrombolysed. Data on complications during such transfers are highly limited.

Patients and methods: Consecutive AIS patients transferred between 01/2015 and 10/2021 to our CSC were included. Associations of major (MACO) and minor (MICO) complications with clinical and imaging data were assessed.

Results: In total, 985 patients were included in the analysis (58.5% thrombolysed). MACO developed in 1.6%, MICO in 14.6%. Compared to patients without complications (NOCO), patients with MACO did not differ in terms of demographics, cerebrovascular risk factors, or site of vessel occlusion. They had more severe strokes (p = 0.026), neurological worsening was more severe (p = 0.008), and transport duration was longer (p = 0.050) but geographical distances did not differ. Thrombolysed patients had any complication more often than patients without thrombolysis (20.3% vs 10.5%; p< 0.001); however, this finding was driven by patients with MICO (p< 0.001) only (MACO: p = 0.804). No associations were observed between stroke severity and complications in either thrombolysed or nonthrombolysed patients. Neurological deterioration during transfer was observed in 21.2%, but multivariate analysis revealed no association with thrombolysis (OR 0.962; 95%CI 0.670-1.380, p = 0.832). Asymptomatic intracerebral hemorrhage was present in 1.1%, symptomatic in 0.1%.

Discussion and conclusion: In this large cohort, no patient-specific factor increasing the risk of complications during interhospital transfer was identified. Specifically, our results do not indicate that thrombolysis increases MACO. Hence, interhospital transfer without EPs appears reasonable in most patients.

导言:急性缺血性卒中(AIS)和大血管闭塞患者经常被急诊医生(EPs)从初级卒中中心转至综合卒中中心(CSC)进行血栓切除术,尤其是溶栓治疗。有关此类转运过程中并发症的数据非常有限:患者和方法:纳入2015年1月至2021年10月期间转入我们CSC的连续AIS患者。评估主要(MACO)和次要(MICO)并发症与临床和影像学数据的关联:共有985名患者被纳入分析(58.5%的患者接受了溶栓治疗)。1.6%的患者出现了MACO,14.6%的患者出现了MICO。与无并发症(NOCO)患者相比,MACO患者在人口统计学、脑血管风险因素或血管闭塞部位方面没有差异。他们的中风程度更严重(p = 0.026),神经功能恶化程度更严重(p = 0.008),转运时间更长(p = 0.050),但地理距离没有差异。与未溶栓的患者相比,溶栓患者出现并发症的比例更高(20.3% vs 10.5%;p 0.001);但这一结果仅出现在 MICO 患者身上(p 0.001)(MACO:p = 0.804)。在溶栓或非溶栓患者中,均未观察到中风严重程度与并发症之间的关联。21.2% 的患者在转运过程中出现神经功能恶化,但多变量分析显示这与溶栓无关(OR 0.962; 95%CI 0.670-1.380, p = 0.832)。1.1%的患者为无症状脑出血,0.1%的患者为有症状脑出血:在这一大型队列中,没有发现患者特异性因素会增加院间转运过程中的并发症风险。特别是,我们的结果并未表明溶栓会增加MACO。因此,对于大多数患者来说,不使用 EPs 的院间转运似乎是合理的。
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引用次数: 0
"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis". "深入了解血栓切除术中的血管穿孔:严重并发症的特征和溶栓治疗的效果"。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-22 DOI: 10.1177/23969873241272542
Victor Schulze-Zachau, Nikki Rommers, Nikolaos Ntoulias, Alex Brehm, Nadja Krug, Ioannis Tsogkas, Matthias Mutke, Thilo Rusche, Amedeo Cervo, Claudia Rollo, Markus Möhlenbruch, Jessica Jesser, Kornelia Kreiser, Katharina Althaus, Manuel Requena, Marc Rodrigo-Gisbert, Tomas Dobrocky, Bettina L Serrallach, Christian H Nolte, Christoph Riegler, Jawed Nawabi, Errikos Maslias, Patrik Michel, Guillaume Saliou, Nathan Manning, Alexander McQuinn, Alon Taylor, Christoph J Maurer, Ansgar Berlis, Daniel Po Kaiser, Ani Cuberi, Manuel Moreu, Alfonso López-Frías, Carlos Pérez-García, Riitta Rautio, Ylikotila Pauli, Nicola Limbucci, Leonardo Renieri, Isabel Fragata, Tania Rodriguez-Ares, Jan S Kirschke, Julian Schwarting, Sami Al Kasab, Alejandro M Spiotta, Ahmad Abu Qdais, Adam A Dmytriw, Robert W Regenhardt, Aman B Patel, Vitor Mendes Pereira, Nicole M Cancelliere, Carsten Schmeel, Franziska Dorn, Malte Sauer, Grzegorz M Karwacki, Jane Khalife, Ajith J Thomas, Hamza A Shaikh, Christian Commodaro, Marco Pileggi, Roland Schwab, Flavio Bellante, Anne Dusart, Jeremy Hofmeister, Paolo Machi, Edgar A Samaniego, Diego J Ojeda, Robert M Starke, Ahmed Abdelsalam, Frans van den Bergh, Sylvie De Raedt, Maxim Bester, Fabian Flottmann, Daniel Weiss, Marius Kaschner, Peter T Kan, Gautam Edhayan, Michael R Levitt, Spencer L Raub, Mira Katan, Urs Fischer, Marios-Nikos Psychogios

Introduction: Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.

Patients and methods: In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.

Results: 459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, p = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, p = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, p = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, p < 0.001).

Discussion and conclusion: Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.

导言:对血栓切除术并发症的研究仍然很少。本研究旨在描述围手术期颅内血管穿孔的特征,包括溶栓对患者预后的影响:在这项多中心回顾性队列研究中,纳入了 2015 年 1 月至 2023 年 4 月期间在血栓切除术中发生血管穿孔的连续患者。血管穿孔的定义是数字减影血管造影中出现活动性外渗。主要结果是90天后的改良Rankin量表(mRS)。采用比例赔率模型评估与主要结果相关的因素:共纳入 459 名血管穿孔患者(平均年龄为 72.5 ± 13.6 岁,59% 为女性,41% 接受了溶栓治疗)。90天后的死亡率为51.9%,16.3%的患者在90天后达到mRS 0-2。溶栓与90天后的预后不相关。大血管(LV)穿孔与中/远端血管穿孔相比,与90天后较差的预后独立相关(aOR 1.709,p = 0.04),LV穿孔与较差的生存概率相关(HR 1.389,p = 0.021)。活动性出血时间超过20分钟的患者生存概率也较低(HR 1.797,P = 0.009)。溶栓与出血持续时间延长无关。与临时措施相比,永久性血管闭塞能更快地止血(中位数差异为 4 分钟,P = 0.009):讨论与结论:血栓切除术中的血管穿孔是一种严重且经常致命的并发症。本研究并未表明溶栓会明显导致预后恶化。在 20 分钟内及时停止活动性出血至关重要,这强调了介入医师接受并发症处理培训的必要性。
{"title":"\"Insights into vessel perforations during thrombectomy: Characteristics of a severe complication and the effect of thrombolysis\".","authors":"Victor Schulze-Zachau, Nikki Rommers, Nikolaos Ntoulias, Alex Brehm, Nadja Krug, Ioannis Tsogkas, Matthias Mutke, Thilo Rusche, Amedeo Cervo, Claudia Rollo, Markus Möhlenbruch, Jessica Jesser, Kornelia Kreiser, Katharina Althaus, Manuel Requena, Marc Rodrigo-Gisbert, Tomas Dobrocky, Bettina L Serrallach, Christian H Nolte, Christoph Riegler, Jawed Nawabi, Errikos Maslias, Patrik Michel, Guillaume Saliou, Nathan Manning, Alexander McQuinn, Alon Taylor, Christoph J Maurer, Ansgar Berlis, Daniel Po Kaiser, Ani Cuberi, Manuel Moreu, Alfonso López-Frías, Carlos Pérez-García, Riitta Rautio, Ylikotila Pauli, Nicola Limbucci, Leonardo Renieri, Isabel Fragata, Tania Rodriguez-Ares, Jan S Kirschke, Julian Schwarting, Sami Al Kasab, Alejandro M Spiotta, Ahmad Abu Qdais, Adam A Dmytriw, Robert W Regenhardt, Aman B Patel, Vitor Mendes Pereira, Nicole M Cancelliere, Carsten Schmeel, Franziska Dorn, Malte Sauer, Grzegorz M Karwacki, Jane Khalife, Ajith J Thomas, Hamza A Shaikh, Christian Commodaro, Marco Pileggi, Roland Schwab, Flavio Bellante, Anne Dusart, Jeremy Hofmeister, Paolo Machi, Edgar A Samaniego, Diego J Ojeda, Robert M Starke, Ahmed Abdelsalam, Frans van den Bergh, Sylvie De Raedt, Maxim Bester, Fabian Flottmann, Daniel Weiss, Marius Kaschner, Peter T Kan, Gautam Edhayan, Michael R Levitt, Spencer L Raub, Mira Katan, Urs Fischer, Marios-Nikos Psychogios","doi":"10.1177/23969873241272542","DOIUrl":"10.1177/23969873241272542","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombectomy complications remain poorly explored. This study aims to characterize periprocedural intracranial vessel perforation including the effect of thrombolysis on patient outcomes.</p><p><strong>Patients and methods: </strong>In this multicenter retrospective cohort study, consecutive patients with vessel perforation during thrombectomy between January 2015 and April 2023 were included. Vessel perforation was defined as active extravasation on digital subtraction angiography. The primary outcome was modified Rankin Scale (mRS) at 90 days. Factors associated with the primary outcome were assessed using proportional odds models.</p><p><strong>Results: </strong>459 patients with vessel perforation were included (mean age 72.5 ± 13.6 years, 59% female, 41% received thrombolysis). Mortality at 90 days was 51.9% and 16.3% of patients reached mRS 0-2 at 90 days. Thrombolysis was not associated with worse outcome at 90 days. Perforation of a large vessel (LV) as opposed to medium/distal vessel perforation was independently associated with worse outcome at 90 days (aOR 1.709, <i>p</i> = 0.04) and LV perforation was associated with poorer survival probability (HR 1.389, <i>p</i> = 0.021). Patients with active bleeding >20 min had worse survival probability, too (HR 1.797, <i>p</i> = 0.009). Thrombolysis was not associated with longer bleeding duration. Bleeding cessation was achieved faster by permanent vessel occlusion compared to temporary measures (median difference: 4 min, <i>p</i> < 0.001).</p><p><strong>Discussion and conclusion: </strong>Vessel perforation during thrombectomy is a severe and frequently fatal complication. This study does not suggest that thrombolysis significantly attributes to worse prognosis. Prompt cessation of active bleeding within 20 min is critical, emphasizing the need for interventionalists to be trained in complication management.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272542"},"PeriodicalIF":5.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke. 与中风后早期发现的心房颤动相比,已知心房颤动患者的复发性血管事件和死亡率结果。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-21 DOI: 10.1177/23969873241272631
Isuru Induruwa, Shiv Bhakta, Rahul Herlekar, Akangsha Sur Roy, Saur Hajiev, Elizabeth A Warburton, Kayvan Khadjooi, John J McCabe

Introduction: Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.

Patients and methods: We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.

Results: 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p = 0.03).

Discussion and conclusion: These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.

导言:卒中后发现的心房颤动(AFDAS)与已知的心房颤动(KAF)可能是不同的临床实体。然而,目前针对 AFDAS 患者的长期预后数据非常有限。需要更多有关 AFDAS 预后的信息,以便为这些患者未来的试验设计提供参考:我们使用了来自全国性前瞻性卒中登记处的数据(2015-2019 年),登记对象为急性缺血性卒中合并房颤的连续患者。AFDAS的定义是心电图或心脏监测发现卒中后新诊断的房颤。共同主要终点为(1) 全因死亡率;(2) 3 年内复发的主要不良心血管事件 (MACE)。次要终点为(1) 复发中风;(2) 出院时的功能预后;(3) 是否同时存在中风机制:结果:共纳入 583 名患者。中位随访 2.65 年(累计 1064 人年)后,309 名患者死亡,23 名患者复发 MACE。与 AFDAS 相比,KAF 与较高的全因死亡风险(调整后危险比 (aHR) 1.56,95% CI 1.12-2.18)、较高的并存卒中机制发生率(调整后几率比 (aOR) 2.28,95% CI 1.14-4.59)相关,但与较差的功能预后无关(aOR 1.61,95% CI 0.98-2.64)。在 KAF 患者中观察到 MACE 风险较高的趋势,但这受到统计能力的限制(aHR 2.90,95% CI 0.67-12.51)。所有 14 例复发性脑卒中均发生在 KAF 组(Log-rank p = 0.03):这些数据进一步证明,在复发性卒中、MACE 和全因死亡率风险方面,AFDAS 与 KAF 存在差异。
{"title":"Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke.","authors":"Isuru Induruwa, Shiv Bhakta, Rahul Herlekar, Akangsha Sur Roy, Saur Hajiev, Elizabeth A Warburton, Kayvan Khadjooi, John J McCabe","doi":"10.1177/23969873241272631","DOIUrl":"10.1177/23969873241272631","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.</p><p><strong>Patients and methods: </strong>We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.</p><p><strong>Results: </strong>583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank <i>p</i> = 0.03).</p><p><strong>Discussion and conclusion: </strong>These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241272631"},"PeriodicalIF":5.8,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reperfusion treatment in basilar artery occlusion presenting with mild symptoms. 对出现轻微症状的基底动脉闭塞进行再灌注治疗。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-20 DOI: 10.1177/23969873241272517
Ghil Schwarz, Angelo Cascio Rizzo, Marius Matusevicius, Tiago Moreira, Aleksandras Vilionskis, Andrea Naldi, Nicolas Martinez-Majander, Guido Bigliardi, Danilo Toni, Christine Roffe, Elio Clemente Agostoni, Niaz Ahmed

Introduction: Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0-10 and 0-5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.

Patients and methods: From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0-10 and 0-5.

Results: 1426 patients were included. For NIHSS scores 0-10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0-5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0-2, aOR 0.20 [95% CI 0.06-0.61]; p = 0.005; mRS 0-3, aOR 0.27 [95% CI 0.08-0.89]; p = 0.031), but safety outcomes were similar.

Discussion: In early-treated BAO patients with mild symptoms, defined as NIHSS 0-10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0-5, IVT alone was associated with better outcomes compared to EVT ± IVT.Conclusion: Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.

简介:血管内治疗(EVT)可改善具有中重度症状的基底动脉闭塞(BAO)的治疗效果。然而,轻度症状(NIHSS 评分 0-10 分和 0-5 分)的最佳治疗方法仍不明确。本研究对轻度症状的 BAO 患者进行了 EVT ± IVT 与单纯 IVT 的比较:从 SITS 国际卒中治疗登记册中,我们纳入了 2013 年至 2021 年期间有基线 NIHSS 评分、在症状出现 6 小时内接受过 EVT、IVT 或两者治疗的 BAO 患者。我们采用双重稳健法(倾向评分匹配加多变量逻辑回归)分析了NIHSS评分为0-10分和0-5分的BAO患者接受EVT±IVT治疗与单独接受IVT治疗的疗效(3个月mRS)和安全性(SICH和3个月死亡):结果:共纳入1426名患者。对于 NIHSS 评分为 0-10 分(180 例匹配,比例为 1:1)的患者,EVT ± IVT 组和单纯 IVT 组的结果相似。对于NIHSS评分0-5分(89例匹配,1:1比例),EVT±IVT组与单纯IVT组相比预后较差(mRS 0-2,aOR 0.20 [95% CI 0.06-0.61];p = 0.005;mRS 0-3,aOR 0.27 [95% CI 0.08-0.89];p = 0.031),但安全性预后相似:讨论:在早期治疗的轻度症状(定义为 NIHSS 0-10)BAO 患者中,EVT ± IVT 和单独 IVT 的疗效无显著差异。然而,对于症状非常轻微(定义为 NIHSS 0-5)的患者,与 EVT ± IVT 相比,单纯 IVT 的疗效更好:结论:随机试验对于确定症状轻微的 BAO 患者的最佳再灌注疗法至关重要。
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引用次数: 0
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European Stroke Journal
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