Terazono Sayaka, Sakaeyama Yuki, Fuchinoue Yutaka, Mikai Masataka, Kubota Shuhei, Abe Mitsuyoshi, Kondo Kosuke, Sugo Nobuo, Nagao Takaaki, Nemoto Masaaki
Department of Neurosurgery (Omori), Faculty of Medicine, Toho University.
Department of Neurosurgery (Sakura), Faculty of Medicine, Toho University.
Neurol Med Chir (Tokyo). 2024 Dec 15;64(12):428-433. doi: 10.2176/jns-nmc.2024-0016. Epub 2024 Nov 6.
Mechanical thrombectomy (MT) is an established treatment for large vessel occlusion in the acute phase of stroke. However, its efficacy and safety in patients with cancer remain unclear. This study aimed to evaluate the therapeutic effect of MT against large vessel occlusion between patients with and without cancer. A total of 71 patients who underwent MT from August 2014 to November 2021 were included in this study. Patients with cancer and/or a history of cancer (n = 16) were included in the with cancer group and the remaining patients in the without cancer group (n = 55). The frequency of preoperative tissue plasminogen activator administration was significantly lower in the with cancer group (n = 2 [12.5%]) than in the without cancer group (n = 24 [43.6%]). However, there were no significant differences between the two groups in terms of treatment time, pass frequency, thrombolysis in cerebral infarction grade, modified Rankin scale score at 1 week after treatment [mRS (1w) ], modified Rankin scale score at discharge [mRS (ENT) ], modified Rankin scale score at 90 days after treatment [mRS (90 days) ], and length of hospital stay (days). In the multivariate analysis, if the objective variables were mRS (1w) and mRS (90 days), the National Institutes of Health Stroke Scale (NIHSS) and preonset mRS scores were considered significant variables. The presence or absence of cancer was not considered an independent factor of mRS (1w), mRS (ENT), or mRS (90 days). Aggressive treatment may be recommended to patients with cancer and/or a history of cancer who present with a systemic condition that can be managed with MT.
机械取栓术(MT)是治疗急性卒中大血管闭塞的一种既定疗法。然而,其在癌症患者中的疗效和安全性仍不明确。本研究旨在评估MT对有癌症和无癌症患者大血管闭塞的治疗效果。本研究纳入了2014年8月至2021年11月期间接受MT治疗的71例患者。有癌症和/或癌症病史的患者(n = 16)被纳入癌症组,其余患者纳入无癌症组(n = 55)。癌症组术前组织型纤溶酶原激活剂的使用频率(n = 2 [12.5%])显著低于无癌症组(n = 24 [43.6%])。然而,两组在治疗时间、通过次数、脑梗死溶栓分级、治疗后1周改良Rankin量表评分[mRS(1w)]、出院时改良Rankin量表评分[mRS(ENT)]、治疗后90天改良Rankin量表评分[mRS(90天)]以及住院天数方面均无显著差异。在多变量分析中,如果目标变量为mRS(1w)和mRS(90天),美国国立卫生研究院卒中量表(NIHSS)和发病前mRS评分被认为是显著变量。癌症的有无并非mRS(1w)、mRS(ENT)或mRS(90天)的独立因素。对于患有癌症和/或有癌症病史且出现可通过MT治疗的全身状况的患者,可能建议采取积极治疗。