Gravbrot Nicholas, McDougall Riley, Aguilar-Salinas Pedro, Avila Mauricio J, Burket Aaron R, Dumont Travis M
Department of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, United States.
Department of Neurosurgery, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, United States.
J Clin Neurosci. 2022 Jul;101:234-238. doi: 10.1016/j.jocn.2022.04.027. Epub 2022 May 28.
Ischemic stroke is a frequently encountered neurologic process with wide-spanning impact. A dreaded complication is "malignant" cerebral edema, necessitating decompression to reduce herniation risk. Following the publication of several landmark trials in 2015, endovascular thrombectomy (EVT) with novel clot-removal devices has emerged as an effective treatment for proximal large vessel disease. Herein, we examine recent national trends in EVT and decompressive craniectomy (DC) rates for acute stroke.
National Inpatient Sample data were abstracted from 2006 to 2016. Primary outcomes were EVT and DC rates, compared using Cochrane-Armitage test of trend. Chi-square test was also used to compare data from 2015 to 2016. Secondary outcomes included inpatient mortality and home discharge rates.
EVT rates steadily increased from 2006 to 2016, with most change occurring from 2014 to 2016 (1.36% in 2014, 2.29% in 2016). DC rates similarly increased from 2006 to 2015, though a sharp decline was observed in 2016 (0.42% in 2015, 0.22% in 2016). Test of trend from 2006 to 2016 for both variables was found to be statistically significant (p = 0.001); DC rate change from 2015 to 2016 was also statistically significant (p < 0.01). Mortality rate and home discharge rate steadily improved over the study period.
Recent innovation in stroke treatment has led to increased EVTs. While DC rate initially followed this same trend, a significant decline was noted in 2016, around the time that wider adoption of novel EVT technologies were instituted in clinical practice.
缺血性中风是一种常见的神经疾病，影响广泛。一种可怕的并发症是“恶性”脑水肿，需要进行减压以降低脑疝风险。在2015年发表了几项具有里程碑意义的试验后，使用新型血栓清除装置的血管内血栓切除术（EVT）已成为近端大血管疾病的有效治疗方法。在此，我们研究了急性中风患者接受EVT和减压颅骨切除术（DC）的近期全国趋势。
提取2006年至2016年的全国住院患者样本数据。主要结果是EVT和DC发生率，使用Cochrane-Armitage趋势检验进行比较。还使用卡方检验比较2015年至2016年的数据。次要结果包括住院死亡率和出院回家率。
从2006年到2016年，EVT发生率稳步上升，大部分变化发生在2014年至2016年（2014年为1.36%，2016年为2.29%）。DC发生率从2006年到2015年同样上升，不过在2016年出现了急剧下降（2015年为0.42%，2016年为0.22%）。发现这两个变量从2006年到2016年的趋势检验具有统计学意义（p = 0.001）；2015年到2016年DC发生率的变化也具有统计学意义（p < 0.01）。在研究期间，死亡率和出院回家率稳步改善。
近期中风治疗的创新导致EVT的使用增加。虽然DC发生率最初也遵循相同趋势，但在2016年出现了显著下降，大约在新型EVT技术在临床实践中更广泛应用的时候。
