沙特阿拉伯前循环大血管闭塞性卒中：患病率、预测因素及预后
Anterior circulation large vessel occlusion stroke in Saudi Arabia: Prevalence, predictors, and outcome.
作者信息
Al Khathaami Ali M, Aldriweesh Mohammed A, Al Bdah Bayan A, Alhasson Muath A, Alsaif Sultan A, Alluhidan Waleed A, Almutairi Faisal M, Alskaini Mohammed A, Alotaibi Nasser, Alghamdi Saeed A M
机构信息
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
出版信息
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105080. doi: 10.1016/j.jstrokecerebrovasdis.2020.105080. Epub 2020 Jun 30.
OBJECTIVE
Anterior circulation Large Vessel Occlusion (LVO) stroke comes with significant morbidity and mortality. With the advent of endovascular interventions, its management has revolutionized. For health authorities to build systems and allocate resources, its burden, predictors, and outcome must be determined.
METHODS
In a single tertiary care center, we retrospectively collected data from 1495 ischemic stroke patients to determine anterior circulation LVO prevalence, predictors, and outcome. Patients must have radiologically proven ischemic stroke within 24 hours before arrival at the emergency department. Anterior circulation LVO related stroke was defined as evidence of new anterior circulation infarct detected on neuroimaging, and vascular imaging confirming anterior circulation Large Vessel Occlusion. Data on demographics, vascular risk factors, treatment with reperfusion therapy, modified Rankin Scale (mRS) at admission, National Institute of Health Stroke Scale (NIHSS) at admission, length of stay (LOS) in days, and in-hospital comorbidities and death were collected. Regression analysis was done to determine the predictors and outcomes of anterior circulation LVO ischemic strokes.
RESULTS
We found anterior circulation LVO in 27.8% (95 % CI 25.5-30.0) of all ischemic stroke patients. Atrial fibrillation and admission National Institute of Health Stroke Scale (NIHSS) were the strongest predictors of LVO [OR 2.33, P = 0.0011 and OR 1.17, P < 0.0001] respectively. Occurrence of LVO was associated with worse disability score (mRS ≥ 3) [47.22 vs. 19.81% (P = 0.0073)], longer hospitalization in days [Median 9.0 vs. 3.0, IQR (14.0 vs. 5.0) P = 0.0432)], and was more likely to results in patient admission to intensive care unit [Mean 17.59 vs. 3.70 % (P = 0.0002)].
CONCLUSION
Stroke with large vessel occlusion in Saudi Arabia is not uncommon. Its burden and outcome deserve national attention, as effective treatment is now readily available.
目的
前循环大血管闭塞（LVO）性卒中具有较高的发病率和死亡率。随着血管内介入治疗的出现，其治疗方式发生了变革。为了让卫生当局建立系统并分配资源，必须确定其负担、预测因素和预后情况。
方法
在一家三级医疗中心，我们回顾性收集了1495例缺血性卒中患者的数据，以确定前循环LVO的患病率、预测因素和预后情况。患者必须在抵达急诊科前24小时内有经影像学证实的缺血性卒中。前循环LVO相关卒中定义为神经影像学检查发现新的前循环梗死证据，且血管造影证实前循环大血管闭塞。收集了患者的人口统计学数据、血管危险因素、再灌注治疗情况、入院时改良Rankin量表（mRS）评分、入院时美国国立卫生研究院卒中量表（NIHSS）评分、住院天数、住院期间的合并症及死亡情况。进行回归分析以确定前循环LVO缺血性卒中的预测因素和预后情况。
结果
我们发现所有缺血性卒中患者中有27.8%（95%可信区间25.5 - 30.0）存在前循环LVO。心房颤动和入院时美国国立卫生研究院卒中量表（NIHSS）评分分别是LVO最强的预测因素[比值比（OR）2.33，P = 0.0011；OR 1.17，P < 0.0001]。LVO的发生与更差的残疾评分（mRS≥3）相关[47.22%对19.81%（P = 0.0073）]，住院天数更长[中位数9.0天对3.0天，四分位数间距（14.0天对5.0天），P = 0.0432]，且更有可能导致患者入住重症监护病房[平均17.59%对3.70%（P = 0.0002）]。
结论
沙特阿拉伯的大血管闭塞性卒中并不少见。由于现在已有有效的治疗方法，其负担和预后值得国家关注。
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