大面积核心缺血性脑卒中的血管内治疗:印度的实际经验

Surabhi Garg, Dileep Ramachandran, Tanaya Mishra, Anush Rangarajan, G. K. Dash, Radhika Manohar, V. Philip, Kuldeep Shetty, Pravin Thomas, Shri Harsha Krishna, Shivakanth Nalubolu, V. Huded
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引用次数: 0

摘要

大核心急性缺血性脑卒中主要被排除在血管内治疗(EVT)研究之外,原因是出血风险较高,功能预后较差。然而,最近的随机对照试验(RCT)表明,与单纯药物治疗相比,大血管闭塞(LVO)脑卒中的 EVT 可改善功能预后,尽管出血转化率较高,但无症状性脑内出血(sICH)率并未相应增加。这一干预措施在印度患者中的实际效果仍未得到充分探索。 为了评估在印度人群中使用 EVT 治疗伴有 LVO 的大核心急性缺血性脑卒中的实际效果。 我们利用前循环卒中患者 EVT 7 年的前瞻性数据库开展了一项单中心回顾性观察研究。研究纳入了阿尔伯塔省卒中项目早期计算机断层扫描评分(ASPECTS)为 3-5 分的患者。对临床和放射学数据进行了分析,主要终点是90天的改良Rankin量表(mRS)评分。安全性结果包括 sICH 发生率和死亡率。使用 Microsoft Excel 进行了描述性统计分析。 研究纳入了25名符合纳入标准的患者。患者的平均年龄为(52.9 ± 14.3)岁,其中男性 13 人(52%)。ASPECTS 中位数为 5(四分位间范围为 4-5)。根据改良的脑梗塞溶栓评分,再通成功率为 92%。9名患者(36%)实现了良好的功能恢复,即90天mRS 0-3。安全结果:4 名患者(16%)出现 sICH,9 名患者(36%)出现死亡。 我们的研究结果再次证实了 RCT 的研究结果,提供了最新的实际证据,并表明 EVT 是大面积核心缺血性梗死患者可以考虑的可行方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endovascular Therapy in Large Core Ischemic Strokes: Real-World Indian Experience
Large core acute ischemic strokes have predominantly been excluded from endovascular therapy (EVT) studies due to perceived higher risks of hemorrhage and poorer functional outcomes. However, recent randomized controlled trials (RCTs) indicate that EVT for large vessel occlusion (LVO) strokes improves functional outcomes compared to medical management alone, despite higher hemorrhagic transformation rates, with no corresponding increase in symptomatic intracerebral hemorrhage (sICH) rates. The real-world outcomes of this intervention in Indian patients remain underexplored. To evaluate the real-world outcomes of EVT for large core acute ischemic strokes with LVO in an Indian population. We conducted a single-center, retrospective observational study using a 7 years prospective database of EVT in anterior circulation stroke patients. Patients with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 3–5 were included. Clinical and radiologic data were analyzed, with the primary endpoint being 90-day modified Rankin scale (mRS) scores. Safety outcomes included rates of sICH and mortality. Descriptive statistical analysis was done using Microsoft Excel. The study included 25 patients who met the inclusion criteria. Mean age of patients was 52.9 ± 14.3 years, and there were 13 (52%) males. Median ASPECTS was 5 (interquartile range 4–5). Successful recanalization, classified by modified Thrombolysis in Cerebral Infarction score, was 92%. Good functional recovery, that is, 90-day mRS 0–3, was achieved in nine (36%) patients. Safety outcomes: sICH was seen in four (16%) and mortality was reported in nine (36%) patients. Our results reaffirm findings from RCTs, provide updated real-world evidence, and suggest that EVT is a viable option to be considered in selected patients with large core ischemic infarcts.
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