Sporns Peter B, Brehm Alex, Hilgers Caroline, Ntoulias Nikolaos, Tsogkas Ioannis, Psychogios Marios
Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Neurol. 2021 Oct 20;12:753183. doi: 10.3389/fneur.2021.753183. eCollection 2021.
Endovascular thrombectomy (EVT) has become the standard of care for large-vessel occlusion strokes, but several barriers for implementing an optimal organization of stroke management remain. Major issues include the lack of reliable data on the percentage of stroke patients potentially eligible for EVT especially in times of expanding indications for EVT. Our aim was therefore to study the frequencies of possible EVT-eligible patients such as patients with medium-vessel occlusions, patients with low Alberta Stroke Program Early Computed Tomography Scores (ASPECTS), patients presenting in an extended time window after onset of symptoms, and patients with mild symptoms at presentation (National Institutes of Health Stroke Scale, NIHSS ≤ 5). We also give detailed imaging and clinical information about the patients presenting with intracranial hemorrhage and other ischemic stroke mimics stratified by symptoms at presentation. Cohort study of all consecutive patients with suspected acute stroke presenting to a tertiary care center in Germany between September 1, 2016, and August 31, 2017. Baseline and follow-up clinical and imaging characteristics were collected from patients' medical charts. Of 1,322 patients with a suspected acute stroke, 592 (44.8%) had ischemic strokes, 221 (16.7%) had hemorrhagic strokes, 190 (10.9%) had transient ischemic attacks (TIAs), and 319 (24.1%) were classified as stroke mimics. Stroke severity was mild (NIHSS ≤ 5) in 866 (65.5%) patients; 15.7% of the patients with an occlusion of the anterior circulation had an ASPECTS ≤ 5, 17.4% of the patients with an ischemic stroke had distal vessel occlusions, and 49% of the patients presented later than 6 h after onset of symptoms. Our results help to plan resources in thrombectomy-capable centers in times of expanding indications for EVT where resources will have to be adjusted to patients with low-NIHSS, low-ASPECTS, and distal occlusions, and patients presenting in the extended time window, which may altogether account for an additional 20% of all ischemic stroke patients.
血管内血栓切除术（EVT）已成为大血管闭塞性卒中的标准治疗方法，但在实施优化的卒中管理组织方面仍存在一些障碍。主要问题包括缺乏关于可能适合接受EVT治疗的卒中患者百分比的可靠数据，尤其是在EVT适应症不断扩大的时期。因此，我们的目的是研究可能适合接受EVT治疗的患者的频率，例如中型血管闭塞患者、阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）较低的患者、症状发作后较长时间窗内就诊的患者以及就诊时症状较轻的患者（美国国立卫生研究院卒中量表，NIHSS≤5）。我们还提供了关于颅内出血患者和其他缺血性卒中模拟疾病患者的详细影像学和临床信息，并根据就诊时的症状进行了分层。对2016年9月1日至2017年8月31日期间在德国一家三级医疗中心就诊的所有疑似急性卒中连续患者进行队列研究。从患者病历中收集基线和随访的临床及影像学特征。在1322例疑似急性卒中患者中，592例（44.8%）为缺血性卒中，221例（16.7%）为出血性卒中，190例（10.9%）为短暂性脑缺血发作（TIA），319例（24.1%）被归类为卒中模拟疾病。866例（65.5%）患者的卒中严重程度为轻度（NIHSS≤5）；前循环闭塞患者中有15.7%的ASPECTS≤5，缺血性卒中患者中有17.4%存在远端血管闭塞，49%的患者在症状发作后6小时以上就诊。我们的研究结果有助于在EVT适应症不断扩大的时期，为有血栓切除术能力的中心规划资源，届时资源将不得不针对NIHSS低、ASPECTS低和远端闭塞的患者以及在延长时间窗内就诊的患者进行调整，这些患者可能总共占所有缺血性卒中患者的20%。
