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合并恶性肿瘤患者血栓切除术的长期临床结果和预后

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy.

作者信息

Oki Sogo, Kawabori Masahito, Echizenya Sumire, Shimoda Yusuke, Shimbo Daisuke, Osanai Toshiya, Uchida Kazuki, Houkin Kiyohiro

机构信息

Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Department of Neurosurgery, Hokkaido Medical Center, Sapporo, Japan.

出版信息

Front Neurol. 2020 Oct 15;11:572589. doi: 10.3389/fneur.2020.572589. eCollection 2020.

Abstract

Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.

摘要

血管内血栓切除术(EVT)是急性缺血性卒中(AIS)患者的首选治疗策略。然而,对于因AIS并伴有恶性肿瘤而接受EVT治疗的患者,其临床结局和预后尚未完全阐明。对2015年1月至2019年4月期间在参与研究的机构接受EVT治疗的恶性肿瘤患者的数据进行了回顾性分析。对12例预先诊断为恶性肿瘤的患者的患者特征、治疗方法、治疗后策略和长期预后进行了评估。12例患者中有10例实现了良好的血管再通(脑梗死溶栓分级2b级或更高)。在发病后存活超过2周的8例患者中,4例在治疗后60天时显示出良好的临床结局[改良Rankin量表(mRS)<2],并且能够继续接受恶性肿瘤治疗。然而,8例患者中有7例在EVT后一年内死亡(中位生存期83天),原因是恶性肿瘤进展。仅1例卒中病因被确定为感染性心内膜炎而非Trousseau综合征的患者存活了一年。即使成功实现血管再通且短期临床结局良好,恶性肿瘤患者血栓切除术后的长期预后仍然很差。对于合并恶性肿瘤的血栓切除术需要谨慎决策,并且需要进一步研究以充分阐明其疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d533/7593531/63f6f57849ea/fneur-11-572589-g0001.jpg

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