对容量超过 50 毫升且灌注严重不匹配的急性缺血性中风进行机械血栓切除术的安全性和有效性。

Surgical neurology international Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI:10.25259/SNI_365_2024
Douglas Gonsales, Eberval Gadelha Figueiredo, Joao Paulo Mota Telles, Pedro Aguilar-Salinas, Nima Amin Aghaebrahim, Eric Sauvageau, Saul Almeida da Silva, Ricardo A Hanel
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引用次数: 0

摘要

研究背景本研究旨在探讨机械性血栓切除术(MT)在急性缺血性脑卒中中的安全性和有效性:这是一项回顾性病例对照研究。方法:这是一项回顾性病例对照研究。研究对象为确诊为广泛缺血性卒中的患者,其缺血容量等于或大于 50 mL,CT 或磁共振成像灌注采用 RAPID® 系统。干预组除接受标准治疗外,还接受使用或不使用重组组织浆细胞酶原激活剂(rt-PA)的血管内介入治疗,对照组则接受使用或不使用重组组织浆细胞酶原激活剂(rt-PA)的保守治疗加标准治疗:共有59名患者入组,其中干预组38人,对照组21人。两组患者的基线特征相似。对照组(中位数 30,四分位数间距 [IQR] 13)和干预组(中位数 8,四分位数间距 [IQR] 14)患者出院时的美国国立卫生研究院卒中量表差异显著(P < 0.001)。干预组(中位数 mRS 2,IQR 3)和对照组(中位数 mRS 5,IQR 1)出院时的改良朗肯量表(mRS)评分差异显著(P = 0.002)。这些 mRS 差异在 90 天后仍然显著,中位数(IQR)分别为 2(2.75)和 5(1)(P < 0.001):MT对灌注严重失配的大核心缺血性脑卒中安全有效,与最佳的药物治疗相比,MT能带来更好的功能预后,且无明显并发症。
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Safety and efficacy of mechanical thrombectomy for acute ischemic stroke with volume over 50 mL and significant perfusion mismatch.

Background: This study aims to address the safety and efficacy of mechanical thrombectomy (MT) in acute ischemic stroke with an established infarction equal to or >50 mL with a significant difference between penumbra and established infarction detected by perfusion cerebral computed tomography (CT) with the Rapid® system.

Methods: This was a retrospective case-control study. Patients diagnosed with established and extensive ischemic stroke, defined by an ischemic volume equal to or >50 mL on CT or magnetic resonance imaging perfusion using the RAPID® system, were examined. The intervention group received endovascular interventional treatment with or without recombinant tissue plasminogen activator (rt-PA) in addition to standard therapy, and the control group received conservative treatment with or without rt-PA plus standard therapy.

Results: A total of 59 patients were enrolled, including 38 in the intervention group and 21 in the control group. Baseline characteristics were similar between groups. Patient National Institutes of Health Stroke Scale at discharge was significantly different between the control (median 30, interquartile range [IQR] 13) and intervention group (median 8, IQR 14) (P < 0.001). Modified Rankin scale (mRS) scores were significantly different at discharge between intervention (median mRS 2, IQR 3) and controls (median mRS 5, IQR 1) (P = 0.002). These mRS differences remained significant at 90 days, with median (IQR) values of 2 (2.75) and 5 (1), respectively (P < 0.001).

Conclusion: MT is safe and effective for large-core ischemic strokes with significant perfusion mismatch, leading to better functional outcomes without significant complications compared to the best medical treatment.

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