Department of Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA.
Department of Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
J Neurointerv Surg. 2022 Oct;14(10):1033-1041. doi: 10.1136/neurintsurg-2021-017888. Epub 2021 Jul 8.
The purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis.
We performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence.
MT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.
本指南旨在总结在通常不包括在大型随机对照临床试验中的特殊人群中进行机械取栓（MT）治疗紧急大血管闭塞（ELVO）卒中的可用数据，包括儿童、老年人、孕妇、近期接受过手术的患者以及血小板减少症、胶原血管疾病和心内膜炎患者。
我们对研究机械取栓治疗年龄<18 岁和>80 岁、孕妇、近期接受过手术的和血小板减少症、胶原血管疾病或心内膜炎患者缺血性卒中的适应证、疗效和结局的文献进行了综述。我们对证据质量进行了分级。
MT 可有效治疗年龄>80 岁和<18 岁、血小板减少症、孕妇和心内膜炎患者的 ELVO 缺血性卒中。与年轻患者和血小板计数正常的患者相比，预后较差（分别为 mRS 和死亡率），但老年患者仍有获益（mRS 和死亡率）。胶原血管疾病患者的数据非常有限；尽管诊断性脑血管造影术风险增加，但在未治疗的 ELVO 可能导致致残或致命结局的情况下，仔细选择患者后，MT 可能是合适的。
