[1]杭 宇,贾振宇,曹月洲,等.急性大血管闭塞性脑卒中静脉溶栓后转诊行血管内治疗预后影响因素分析[J].介入放射学杂志,2022,31(04):383-387.
 HANG Yu,JIA Zhenyu,CAO Yuezhou,et al.Analysis of factors influencing prognosis in patients with acute ischemic stroke due to large vessel occlusion referred to endovascular treatment after receiving thrombolysis[J].journal interventional radiology,2022,31(04):383-387.
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急性大血管闭塞性脑卒中静脉溶栓后转诊行血管内治疗预后影响因素分析()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
31
期数:
2022年04
页码:
383-387
栏目:
临床研究
出版日期:
2022-06-15

文章信息/Info

Title:
Analysis of factors influencing prognosis in patients with acute ischemic stroke due to large vessel occlusion referred to endovascular treatment after receiving thrombolysis
作者:
杭 宇 贾振宇 曹月洲 赵林波 周 春 祁 涛 施海彬 刘 圣
Author(s):
HANG Yu JIA Zhenyu CAO Yuezhou ZHAO Linbo ZHOU Chun QI Tao SHI Haibin LIU Sheng.
Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, China
关键词:
【关键词】 急性缺血性脑卒中 静脉溶栓 转诊 血管内治疗 临床预后 影响因素
文献标志码:
A
摘要:
【摘要】 目的 探讨急性大血管闭塞性脑卒中(AIS-LVO)患者静脉溶栓后转诊行血管内治疗的安全性和有效性,分析影响预后的因素。 方法 回顾性分析2018年1月至2020年12月在卒中防治中心静脉溶栓后转至南京医科大学第一附属医院行机械取栓术的AIS-LVO患者临床资料。根据机械取栓治疗后90 d改良Rankin量表(mRS)评分,将患者分为预后良好组(mRS评分≤2)和预后不良组(mRS评分>2)。单因素和多因素logistic回归分析患者预后相关危险因素。 结果 共41例AIS-LVO患者纳入研究,其中预后良好组16例(39.0%)。将单因素分析中变量(P<0.05)纳入多因素logistic回归分析,结果显示术前美国国立卫生研究院卒中量表(NIHSS)评分高、Alberta卒中项目早期CT评分(ASPECTS)低、卒中症状发作至卒中防治中心就诊时间(ODT)长以及卒中防治中心就诊至股动脉穿刺时间(DPT)长,均为AIS-LVO患者预后不良的独立危险因素(P<0.05)。结论 AIS-LVO患者静脉溶栓后转诊行血管内治疗安全有效。术前NIHSS评分、ASPECTS、ODT、DPT是患者临床预后的预测因素。

参考文献/References:

[1] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018[J]. 中华神经科杂志, 2018, 51:666-682.
[2] Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med, 2018, 378: 11-21.
[3] Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med, 2018, 378: 708-718.
[4] Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke[J]. New Engl J Med, 2008, 359: 1317-1329.
[5] Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50: e344-e418.
[6] Josephson SA, Kamel H. The acute stroke care revolution: enhancing access to therapeutic advances[J]. JAMA, 2018, 320: 1239-1240.
[7] 《中国脑卒中防治报告2019》编写组. 《中国脑卒中防治报告2019》概要[J]. 中国脑血管病杂志, 2020, 17: 272-281.
[8] Sheth KN, Smith EE, Grau-Sepulveda MV, et al. Drip and ship thrombolytic therapy for acute ischemic stroke: use, temporal trends, and outcomes[J]. Stroke, 2015, 46: 732-739.
[9] Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke[J]. N Engl J Med, 2020, 382: 1981-1993.
[10] Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial[J]. JAMA, 2021, 325: 244-253.
[11] Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial[J]. JAMA, 2021, 325: 234-243.
[12] Wang Y, Wu X, Zhu C, et al. Bridging thrombolysis achieved better outcomes than direct thrombectomy after large vessel occlusion: an updated meta- analysis[J]. Stroke, 2021, 52: 356-365.
[13] Mistry EA, Mistry AM, Nakawah MO, et al. Mechanical throm-bectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis[J]. Stroke, 2017, 48: 2450-2456.
[14] Tsivgoulis G, Katsanos AH, Mavridis D, et al. Endovascular thrombectomy with or without systemic thrombolysis?[J]. Ther Adv Neurol Disord, 2017, 10: 151-160.
[15] Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke- monitoring study(SITS-MOST): an obser-vational study[J]. Lancet, 2007, 369: 275-282.
[16] Abdul-Rahim AH, Fulton RL, Sucharew H, et al. National institutes of health stroke scale item profiles as predictor of patient outcome: external validation on Independent trial data[J]. Stroke, 2015, 46: 395-400.
[17] Tan BY, Wan-Yee K, Paliwal P, et al. Good intracranial collaterals trump poor ASPECTS(Alberta stroke program early CT score) for intravenous thrombolysis in anterior circulation acute ischemic stroke[J]. Stroke, 2016, 47: 2292-2298.
[18] Jahan R, Saver JL, Schwamm LH, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice[J]. JAMA, 2019, 322: 252-263.
[19] Kodankandath TV, Wright P, Power PM, et al. Improving transfer times for acute ischemic stroke patients to a comprehensive stroke center[J]. J Stroke Cerebrovasc Dis, 2017, 26: 192-195.
[20] 陆小小,许 磊,苏浩波,等. 急性缺血性脑卒中桥接治疗临床效果及预后影响因素探讨[J]. 介入放射学杂志, 2021, 30:595-599.

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备注/Memo

备注/Memo:
(收稿日期:2021- 05- 08)
(本文编辑:边 佶)
更新日期/Last Update: 2022-05-11