急性缺血性脑卒中治疗性抗凝期间的机械取栓：长期结果。
Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes.
机构信息
Neurology Department, Jagiellonian University, Krakow, Poland.
Neurology Department, University Hospital in Krakow.
出版信息
Neurol Neurochir Pol. 2020;54(6):538-543. doi: 10.5603/PJNNS.a2020.0088. Epub 2020 Nov 17.
AIM OF STUDY
Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90.
CLINICAL RATIONALE FOR THE STUDY
Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited.
MATERIALS AND METHODS
This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death).
RESULTS
Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55).
CONCLUSION AND CLINICAL IMPLICATIONS
In anticoagulated patients with AIS, MT does not affect long-term outcomes.
研究目的
机械血栓切除术（MT）是推荐用于急性缺血性卒中（AIS）抗凝患者的病因治疗选择之一。我们使用改良 Rankin 评分（mRS）或 90 天死亡率分析其长期结局。
研究临床背景
描述 MT 在 AIS 患者中的抗凝疗效和安全性的数据有限。
材料和方法
本研究纳入了 291 名在波兰克拉科夫综合卒中中心接受 MT 的 AIS 患者（49%为女性，平均[标准差]年龄 66[15]岁）。收集描述人口统计学、卒中危险因素、入院时 NIHSS、术后脑梗死溶栓评分、24 小时后 CT 上的出血性转化（ECASS-2）以及卒中发作和腹股沟穿刺之间的时间。结局测量为卒中发作后 90 天的 mRS（预后良好定义为 mRS 不超过 2 分；预后不良定义为死亡）。
结果
37 名患者（13%）在 MT 期间接受了治疗性抗凝。单因素分析显示，抗凝患者年龄更大，更有可能被诊断为高血压、缺血性心脏病或心房颤动。两组患者在血栓位置、术后脑梗死溶栓评分、CT 上的出血性转化或 90 天 mRS 方面无差异。多变量逻辑回归分析显示，年龄较小、男性、无糖尿病病史、入院 NIHSS 评分较低、卒中发作和腹股沟穿刺之间的时间较短、再通较好与 90 天的良好结局相关，而治疗性抗凝则无相关性（OR，1.00；95%CI，0.46-2.15；p=0.99）。抗凝并不影响 90 天死亡率（OR，1.28；95%CI，0.56-2.92；p=0.55）。
结论和临床意义
在 AIS 合并抗凝的患者中，MT 不影响长期结局。
Zotero 插件