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 European Stroke Journal 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
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引用次数: 0

摘要

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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Medical complications during interhospital transfer for thrombectomy in patients with acute ischemic stroke.

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.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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