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[前循环急性缺血性卒中:血管内治疗]

[Acute ischemic stroke in anterior territory: endovascular treatment].

作者信息

Cirio Juan J, Ciardi Celina, Vila José F, Buezas Mariano D, Scrivano Esteban, Chudyk-Huberuk Jorge P, Diluca Pablo, Ingino Carlos, Lylyk Pedro

机构信息

Unidad de ACV, Clínica La Sagrada Familia, Buenos Aires, Argentina. E-mail:

Unidad de ACV, Clínica La Sagrada Familia, Buenos Aires, Argentina.

出版信息

Medicina (B Aires). 2020;80(3):211-218.

Abstract

Endovascular treatment (EVT) has become the standard of care for acute ischemic stroke (AIS) with proximal large vessel occlusions (LVO). However, it is still unknown whether these results can be generalized to clinical practice. We aimed to perform a retrospective review of patients who received EVT up to 24 hours, and to assess safety and efficacy in everyday clinical practice. We performed a retrospective analysis, from January 2013 to December 2017, on 139 consecutive patients with AIS for anterior circulation LVO strokes up to 24 h from symptoms onset, who received EVT in our institution. The primary outcome measured was a modified Rankin scale (mRS) = 2 at 90 days. Secondary outcomes included successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) scale 2b/3, mortality rate at 90 days and symptomatic intracranial hemorrhage (sICH). The mean age was 67.5 ± 15.0, with 51.8% female patients. Median baseline National Institute of Health Stroke Scale (NIHSS) was 14 (IQR 8-18); median time from symptom onset to groin puncture was 331 min (IQR 212-503). Sixty-three patients (45.3%) were treated beyond 6 hours after symptoms onset. The rate of mRS = 2 was 47.5%. Successful reperfusion was achieved in 74.8 %. Mortality rate at 90 days was 18.7 % and sICH was 7.9 %. Our registry of real-life patients with AIS due to LVO who received EVT within 24 hours showed high reperfusion rates, and good functional results with few complications, according to international recommendations.

摘要

血管内治疗(EVT)已成为近端大血管闭塞(LVO)所致急性缺血性卒中(AIS)的标准治疗方法。然而,这些结果能否推广到临床实践仍不清楚。我们旨在对接受EVT治疗长达24小时的患者进行回顾性研究,并评估日常临床实践中的安全性和有效性。我们对2013年1月至2017年12月期间在我们机构接受EVT治疗的139例症状发作后长达24小时的前循环LVO卒中AIS连续患者进行了回顾性分析。测量的主要结局是90天时改良Rankin量表(mRS)=2。次要结局包括成功再灌注,定义为改良脑梗死溶栓(mTICI)量表2b/3、90天死亡率和症状性颅内出血(sICH)。平均年龄为67.5±15.0岁,女性患者占51.8%。基线美国国立卫生研究院卒中量表(NIHSS)中位数为14(四分位间距8-18);从症状发作到股动脉穿刺的中位时间为331分钟(四分位间距212-503)。63例患者(45.3%)在症状发作后6小时以上接受治疗。mRS=2的比例为47.5%。成功再灌注率为74.8%。90天死亡率为18.7%,sICH为7.9%。我们对24小时内接受EVT治疗的LVO所致AIS真实患者的登记研究显示,根据国际推荐,再灌注率高,功能结果良好,并发症少。

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