急诊大血管闭塞性脑卒中转血管内取栓患者的梗死生长。

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY Neurology and Therapy Pub Date : 2025-02-01 Epub Date: 2024-12-19 DOI:10.1007/s40120-024-00689-4

Xiangjun Xu, Yujuan Zhu, Yapeng Guo, Hao Wang, Junfeng Xu, Ke Yang, Liang Ge, Yi Sun, Xianhui Ding, Qian Yang, Chuyuan Ni, Xianjun Huang

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引用次数: 0

摘要

大血管闭塞（LVO）卒中患者被转移到综合卒中中心（CSC）进行血管内血栓切除术（EVT）时，通常会经历梗死生长。我们的目的是研究快速梗死生长的临床预测因素及其对临床结果的影响。方法：回顾性收集2019年3月14日至2022年6月28日转入本中心的LVO患者的EVT数据。阿尔伯塔中风项目早期计算机断层扫描评分（ASPECTS）衰减的绝对速率定义为（ASPECTS初级CT - ASPECTS重复CT）/经过的小时数。相关方面恶化的比值定义为(ASPECTS primary CT - ASPECTS repeat CT)/ASPECTS primary CT。在初步分析中，研究人群被分为绝对缓慢进展者和绝对快速进展者，使用ASPECTS衰退的绝对中位数。采用相对ASPECTS恶化比率中位数进行二次分析，并将研究人群分为相对快速进展者和相对缓慢进展者。90天改良Rankin量表（mRS）评分≤2分定义为预后良好。结果：我们纳入309例患者：中位年龄72岁（IQR 65-77）；美国国立卫生研究院卒中量表（NIHSS）中位数为14 （IQR 11-18）。ASPECTS衰退的绝对速度中位数为0.42分/小时，相对恶化率中位数为11.1%。总体而言，快速梗死增长与较差的90天预后独立相关(方面衰退的绝对比率：OR = 3.395；95% ci 1.844-6.250；结论：对于从PSC转移到CSC进行EVT的LVO卒中患者，梗死生长速率是高度可变的，并且与90天的预后密切相关。在转移前开始静脉搭桥治疗可以限制医院间转移期间梗死的增长。

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Infarct Growth in Patients with Emergent Large Vessel Occlusion Stroke Transferred for Endovascular Thrombectomy.

Introduction: Patients with a large vessel occlusion (LVO) stroke who are transferred to a comprehensive stroke center (CSC) for endovascular thrombectomy (EVT) often experience infarct growth. We aimed to investigate the clinical predictors of fast infarct growth and its effect on clinical outcomes.

Methods: We retrospectively collected EVT data of patients with LVO transferred to our center between March 14, 2019, and June 28, 2022. The absolute rate of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) decay was defined as (ASPECTS primary CT - ASPECTS repeat CT)/elapsed hours. The ratio of relative ASPECTS deterioration was defined as (ASPECTS primary CT - ASPECTS repeat CT)/ASPECTS primary CT. In the primary analysis, the study population was dichotomized into absolute slow progressors and absolute fast progressors using the median absolute rate of ASPECTS decay. Secondary analysis was also conducted using the median relative ASPECTS deterioration ratio, and the study population was categorized into relative fast progressors and relative slow progressors. Favorable outcome was defined as a 90-day modified Rankin Scale (mRS) score ≤ 2.

Results: We included 309 patients: median age 72 years (IQR 65-77); median National Institutes of Health Stroke Scale (NIHSS) 14 (IQR 11-18). The median absolute rate of ASPECTS decay was 0.42 points/hour and the median relative ASPECTS deterioration ratio was 11.1%. Overall, fast infarct growth was independently associated with worse 90-day outcome (absolute rate of ASPECTS decay: OR = 3.395; 95% CI 1.844-6.250; P < 0.001; relative ASPECTS deterioration ratio: OR = 3.754; 95% CI 2.050-6.873; P < 0.001). In multivariable analysis, fast infarct growth was independently associated with high admission NIHSS, proximal occlusions, and poor collateral status, while intravenous thrombolysis before transfer was negative with fast inter-hospital infarct growth.

Conclusions: For patients with LVO stroke who are transferred from a PSC to CSC for EVT, the infarct growth rate is highly variable and is strongly associated with 90-day outcomes. Initiation of intravenous bridging therapy before transfer may limit the infarct growth during inter-hospital transfer.

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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