Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
J Clin Neurol. 2014 Jan;10(1):17-23. doi: 10.3988/jcn.2014.10.1.17. Epub 2014 Jan 6.
Aggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posterior-circulation (vertebrobasilar) strokes. Outcomes were compared across age groups.
The United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively.
During 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4% versus 47.4%, p<0.01) and those aged ≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IV-tPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% for patients aged 50-64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92).
Patients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.
由于这些梗死相关的高发病率和死亡率，积极治疗后循环闭塞非常重要。评估了一个大型行政数据库，以确定机械血栓切除术和静脉组织型纤溶酶原激活剂（IV-tPA）治疗后循环（椎基底动脉）卒中的结果。结果按年龄组进行了比较。
使用美国全国住院患者样本评估 2006 年至 2010 年间接受后循环急性缺血性卒中治疗的患者的结局。选择接受血管内机械血栓切除术和 IV-tPA 的患者。主要结局为出院状态和死亡率；次要结局为住院时间、颅内出血发生率、气管切开术以及经皮内镜胃造口术/空肠造口术管放置率。根据年龄（<50 岁、50-64 岁和≥65 岁）对结果进行分组。分别使用卡方检验和学生 t 检验比较分类变量和连续变量。
在 2006 年至 2010 年期间，有 36675 例患者出院时国际疾病分类（第 9 版）编码提示后循环卒中。其中，631 例（1.7%）接受机械血栓切除术，1554 例（4.2%）接受 IV-tPA。机械血栓切除术患者的院内死亡率对于年龄<50 岁的患者明显低于年龄 50-64 岁的患者（30.4%比 47.4%，p<0.01）和年龄≥65 岁的患者（30.4%比 43.0%，p≤0.01）。年龄对 IV-tPA 患者的院内死亡率没有影响，年龄<50 岁的患者发生率为 22.7%，50-64 岁的患者为 25.4%（p=0.46），年龄≥65 岁的患者为 23.0%（p=0.92）。
接受 IV-tPA 和/或机械血栓切除术治疗后循环卒中的患者死亡率较高。在后循环卒中患者中，年龄增加与机械血栓切除术治疗的患者死亡率显著升高相关。
