Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospecti...Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.展开更多
目的探讨围手术期血压管理对前循环大血管闭塞急性缺血性脑卒中(AIS-LVO)血管再通患者预后的影响。方法回顾性纳入2018年3月至2019年6月我院脑血管病中心连续收治的行血管内治疗后血管成功再通[脑梗死溶栓(TICI)分级≥2b级]的前循环AIS-...目的探讨围手术期血压管理对前循环大血管闭塞急性缺血性脑卒中(AIS-LVO)血管再通患者预后的影响。方法回顾性纳入2018年3月至2019年6月我院脑血管病中心连续收治的行血管内治疗后血管成功再通[脑梗死溶栓(TICI)分级≥2b级]的前循环AIS-LVO患者。对预后良好(改良Rankin量表评分≤2分)的影响因素进行单因素分析,将单因素分析中P<0.1的变量纳入多因素logistic回归分析,确定术后24 h平均收缩压(mSBP)对预后的影响。根据术后24 h mSBP将患者分为低mSBP[100~<120 mmHg(1 mmHg=0.133 kPa)]组、中mSBP(120~140 mmHg)组和高mSBP(>140~160 mmHg)组,比较3组患者术后3个月预后良好率、死亡率及术后24 h症状性颅内出血(sICH)发生率,然后将患者分为低中mSBP(100~140 mmHg)组与高mSBP(>140~160 mmHg)组进行预后分析。结果共纳入患者238例,其中术后3个月预后良好161例(67.65%),预后不良77例(32.35%)。预后良好组患者年龄、术前和术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、术前核心梗死体积(脑血流量<30%的脑组织体积)及术后24 h mSBP均低于预后不良组,术前Alberta脑卒中计划早期计算机断层扫描评分(ASPECTS)高于预后不良组,差异均有统计学意义(P均<0.05)。多因素logistic回归分析显示,术前ASPECTS(OR=1.338,95% CI 1.081~1.657,P=0.007)、术后24 h NIHSS评分(OR=0.838,95% CI 0.785~0.894,P<0.001)和术后24 h mSBP(OR=0.966,95% CI 0.937~0.996,P=0.031)是预后的独立影响因素。随着mSBP增高,术后3个月死亡率和术后24 h sICH发生率均升高(P=0.001、0.032),而术后3个月预后良好率略有下降但差异无统计学意义(P=0.060)。低中mSBP组患者的术后3个月预后良好率高于高mSBP组(P=0.04),术后24 h sICH发生率低于高mSBP组(P=0.01),术后3个月死亡率与高mSBP组相比差异无统计学意义(P=0.19)。结论术后24 h mSBP是前循环AIS-LVO血管再通患者预后的独立影响因素。建议将此类患者术后24 h mSBP控制在≤140 mmHg,如果出血转化的风险大则可控制在≤120 mmHg。展开更多
目的:探讨Solitaire AB支架取栓联合丁苯酞氯化钠注射液对急性前循环大血管闭塞性卒中病人血清同型半胱氨酸(homocysteine,HCY)、胎盘生长因子(placental growth factor,PLGF)及美国国立卫生研究院卒中量表(National Institute of Healt...目的:探讨Solitaire AB支架取栓联合丁苯酞氯化钠注射液对急性前循环大血管闭塞性卒中病人血清同型半胱氨酸(homocysteine,HCY)、胎盘生长因子(placental growth factor,PLGF)及美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、mRS评分的影响。方法:选取急性前循环大血管闭塞性卒中病人120例为研究对象,采取随机数表法将病人分为对照组和观察组,各60例。对照组病人采用Solitaire AB支架取栓治疗,观察组病人在对照组的基础上给予丁苯酞氯化钠注射液,比较2组病人血清HCY、PLGF含量及NIHSS评分、mRS评分。结果:治疗前,2组病人临床病理学资料以及各项指标差异均无统计学意义(P>0.05);治疗后,观察组病人术后即刻血清HCY表达水平(17.35±5.01)μmol/L,术后14 d表达水平(13.79±3.13)μmol/L,分别低于对照组病人术后即刻表达水平(21.54±4.95)μmol/L和术后14 d表达水平(16.65±4.23)μmol/L(P<0.01);观察组病人PLGF术后14 d表达水平(62.35±7.26)ng/L,低于对照组的(79.28±9.13)ng/L(P<0.01);治疗后,2组病人NIHSS评分、mRS评分均下降(P<0.01),其中对照组病人治疗14 d后NIHSS评分为(17.52±3.37)分,高于观察组的(13.28±3.19)分(P<0.01);对照组病人mRS评分≤2者占比为28.33%,低于观察组的68.33%(P<0.01)。结论:Solitaire AB支架取栓联合丁苯酞氯化钠注射液治疗能有效降低急性前循环大血管闭塞性卒中病人血清HCY表达水平、PLGF水平和病人NIHSS、mRS评分,提高临床疗效。展开更多
目的探讨凝视-面-臂-言语-时间(gaze-face-arm-speech-time,G-FAST)评分对院前急救卒中前循环大血管闭塞(large vessel occlusion in the anterior circulation,aLVO)的诊断价值。方法选取2019年7月至2020年12月北京急救中心直属5个分...目的探讨凝视-面-臂-言语-时间(gaze-face-arm-speech-time,G-FAST)评分对院前急救卒中前循环大血管闭塞(large vessel occlusion in the anterior circulation,aLVO)的诊断价值。方法选取2019年7月至2020年12月北京急救中心直属5个分中心送至宣武医院,且有完整院前G-FAST评分和入院诊断信息的卒中患者,根据缺血性卒中患者是否发生LVO分为LVO和非LVO组,采用ROC曲线分析G-FAST评分对院前卒中急救aLVO的诊断价值。结果纳入患者352例,其中急性缺血性卒中占比69.0%(243/352)。进行大血管评估的急性缺血性卒中患者149例,占急性缺血性卒中的61.3%(149/243);发生aLVO患者61例,占大血管病变评估的40.9%(61/149)、占急性缺血性卒中的25.1%(61/243)。149例大血管评估的急性缺血性卒中患者中,男100例,女49例;年龄18~93岁,平均70.5岁。与非aLVO组相比,aLVO组女性较多,G-FAST评分较高,差异均有统计学意义(P<0.05)。G-FAST≥3分患者的aLVO发生率显著高于G-FAST≤2分者(68.9%比31.1%),差异有统计学意义(P<0.05)。G-FAST评分诊断院前急救卒中aLVO的ROC曲线的AUC为0.675(95%CI:0.589~0.761,P=0.000),G-FAST的cut-off值为2.5分时,灵敏度为72.10%,特异度为58.00%。结论G-FAST评分在院前急救卒中可准确识别急性缺血性患者aLVO,早诊断aLVO将利于急性缺血性患者尽早送至高级别卒中中心。展开更多
基金supported by Health Science and Technology Project of Inner Mongolia Autonomous Region 2022(202201571).
文摘Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.
文摘目的探讨围手术期血压管理对前循环大血管闭塞急性缺血性脑卒中(AIS-LVO)血管再通患者预后的影响。方法回顾性纳入2018年3月至2019年6月我院脑血管病中心连续收治的行血管内治疗后血管成功再通[脑梗死溶栓(TICI)分级≥2b级]的前循环AIS-LVO患者。对预后良好(改良Rankin量表评分≤2分)的影响因素进行单因素分析,将单因素分析中P<0.1的变量纳入多因素logistic回归分析,确定术后24 h平均收缩压(mSBP)对预后的影响。根据术后24 h mSBP将患者分为低mSBP[100~<120 mmHg(1 mmHg=0.133 kPa)]组、中mSBP(120~140 mmHg)组和高mSBP(>140~160 mmHg)组,比较3组患者术后3个月预后良好率、死亡率及术后24 h症状性颅内出血(sICH)发生率,然后将患者分为低中mSBP(100~140 mmHg)组与高mSBP(>140~160 mmHg)组进行预后分析。结果共纳入患者238例,其中术后3个月预后良好161例(67.65%),预后不良77例(32.35%)。预后良好组患者年龄、术前和术后24 h美国国立卫生研究院卒中量表(NIHSS)评分、术前核心梗死体积(脑血流量<30%的脑组织体积)及术后24 h mSBP均低于预后不良组,术前Alberta脑卒中计划早期计算机断层扫描评分(ASPECTS)高于预后不良组,差异均有统计学意义(P均<0.05)。多因素logistic回归分析显示,术前ASPECTS(OR=1.338,95% CI 1.081~1.657,P=0.007)、术后24 h NIHSS评分(OR=0.838,95% CI 0.785~0.894,P<0.001)和术后24 h mSBP(OR=0.966,95% CI 0.937~0.996,P=0.031)是预后的独立影响因素。随着mSBP增高,术后3个月死亡率和术后24 h sICH发生率均升高(P=0.001、0.032),而术后3个月预后良好率略有下降但差异无统计学意义(P=0.060)。低中mSBP组患者的术后3个月预后良好率高于高mSBP组(P=0.04),术后24 h sICH发生率低于高mSBP组(P=0.01),术后3个月死亡率与高mSBP组相比差异无统计学意义(P=0.19)。结论术后24 h mSBP是前循环AIS-LVO血管再通患者预后的独立影响因素。建议将此类患者术后24 h mSBP控制在≤140 mmHg,如果出血转化的风险大则可控制在≤120 mmHg。
文摘目的:探讨Solitaire AB支架取栓联合丁苯酞氯化钠注射液对急性前循环大血管闭塞性卒中病人血清同型半胱氨酸(homocysteine,HCY)、胎盘生长因子(placental growth factor,PLGF)及美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、mRS评分的影响。方法:选取急性前循环大血管闭塞性卒中病人120例为研究对象,采取随机数表法将病人分为对照组和观察组,各60例。对照组病人采用Solitaire AB支架取栓治疗,观察组病人在对照组的基础上给予丁苯酞氯化钠注射液,比较2组病人血清HCY、PLGF含量及NIHSS评分、mRS评分。结果:治疗前,2组病人临床病理学资料以及各项指标差异均无统计学意义(P>0.05);治疗后,观察组病人术后即刻血清HCY表达水平(17.35±5.01)μmol/L,术后14 d表达水平(13.79±3.13)μmol/L,分别低于对照组病人术后即刻表达水平(21.54±4.95)μmol/L和术后14 d表达水平(16.65±4.23)μmol/L(P<0.01);观察组病人PLGF术后14 d表达水平(62.35±7.26)ng/L,低于对照组的(79.28±9.13)ng/L(P<0.01);治疗后,2组病人NIHSS评分、mRS评分均下降(P<0.01),其中对照组病人治疗14 d后NIHSS评分为(17.52±3.37)分,高于观察组的(13.28±3.19)分(P<0.01);对照组病人mRS评分≤2者占比为28.33%,低于观察组的68.33%(P<0.01)。结论:Solitaire AB支架取栓联合丁苯酞氯化钠注射液治疗能有效降低急性前循环大血管闭塞性卒中病人血清HCY表达水平、PLGF水平和病人NIHSS、mRS评分,提高临床疗效。
文摘目的探讨凝视-面-臂-言语-时间(gaze-face-arm-speech-time,G-FAST)评分对院前急救卒中前循环大血管闭塞(large vessel occlusion in the anterior circulation,aLVO)的诊断价值。方法选取2019年7月至2020年12月北京急救中心直属5个分中心送至宣武医院,且有完整院前G-FAST评分和入院诊断信息的卒中患者,根据缺血性卒中患者是否发生LVO分为LVO和非LVO组,采用ROC曲线分析G-FAST评分对院前卒中急救aLVO的诊断价值。结果纳入患者352例,其中急性缺血性卒中占比69.0%(243/352)。进行大血管评估的急性缺血性卒中患者149例,占急性缺血性卒中的61.3%(149/243);发生aLVO患者61例,占大血管病变评估的40.9%(61/149)、占急性缺血性卒中的25.1%(61/243)。149例大血管评估的急性缺血性卒中患者中,男100例,女49例;年龄18~93岁,平均70.5岁。与非aLVO组相比,aLVO组女性较多,G-FAST评分较高,差异均有统计学意义(P<0.05)。G-FAST≥3分患者的aLVO发生率显著高于G-FAST≤2分者(68.9%比31.1%),差异有统计学意义(P<0.05)。G-FAST评分诊断院前急救卒中aLVO的ROC曲线的AUC为0.675(95%CI:0.589~0.761,P=0.000),G-FAST的cut-off值为2.5分时,灵敏度为72.10%,特异度为58.00%。结论G-FAST评分在院前急救卒中可准确识别急性缺血性患者aLVO,早诊断aLVO将利于急性缺血性患者尽早送至高级别卒中中心。
