关于大血管闭塞性急性缺血性脑卒中溶栓治疗方法的全球调查。

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2024-08-01 Epub Date: 2024-05-31 DOI:10.1212/CPJ.0000000000200317
Nishita Singh, Nima Kashani, Alonso G Zea Vera, Aleksander Tkach, Aravind Ganesh
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引用次数: 0

摘要

背景和目的:最近的试验表明,在治疗急性缺血性卒中方面,单纯血管内血栓切除术(EVT)可能不优于阿替普酶和 EVT 联合静脉溶栓术(IVT),而且替奈替普酶在治疗急性缺血性卒中方面也不优于阿替普酶,因此我们试图了解目前世界各地治疗大血管闭塞(LVO)急性缺血性卒中的方法,具体取决于实践中心(有 IVT 能力的卒中中心 vs 有 IVT 和 EVT 能力的卒中中心):神经病学》杂志 "Practice Current "栏目发起的电子调查:方法:《神经病学:临床实践》的 "Practice Current "栏目发起的电子调查包括 6 个临床问题和 8 个人口统计学问题。单例病例:一名 65 岁男性,右侧偏瘫伴失语,病程 1 小时。影像学检查显示左侧 M1-MCA 闭塞,无早期缺血性改变。受访者被问及他们在两种情况下的治疗方法:患者就诊于(1)仅能进行 IVT 的中心和(2)能进行 IVT 和 EVT 的中心。受访者还被问及在当前和理想情况下选择的溶栓药物:共有来自 44 个国家的 203 名医生(42.9% 为血管神经科医生)完成了调查。大多数参与者(55.2%)用于提供卒中治疗的时间≥50%。调查结果显示,在目前的实践中,90% 以上的受访者会为在具备 EVT 能力(91.1%)或仅具备 IVT 能力(93.6%)的中心就诊的 LVO 中风患者提供 IVT + EVT。尽管近 80% 的受访者目前使用阿替普酶溶栓,但约 60% 的受访者希望转用替奈普酶,而与实践环境无关。这些结果在脑卒中和非脑卒中神经内科医生中相似:讨论:对于大血管闭塞导致的急性缺血性卒中患者,大多数医生倾向于先进行 IVT,然后再进行 EVT,与诊疗环境无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Worldwide Survey on Approach to Thrombolysis in Acute Ischemic Stroke With Large Vessel Occlusion.

Background and objectives: With recent trials suggesting that endovascular thrombectomy (EVT) alone may be noninferior to combined intravenous thrombolysis (IVT) with alteplase and EVT and that tenecteplase is non-inferior to alteplase in treating acute ischemic stroke, we sought to understand current practices around the world for treating acute ischemic stroke with large vessel occlusion (LVO) depending on the center of practice (IVT-capable vs IVT and EVT-capable stroke center).

Methods: The electronic survey launched by the Practice Current section of Neurology: Clinical Practice included 6 clinical and 8 demographic questions. A single-case scenario was presented of a 65-year-old man presenting with right hemiplegia with aphasia with a duration of 1 hour. Imaging showed left M1-MCA occlusion with no early ischemic changes. The respondents were asked about their treatment approach in 2 settings: the patient presented to (1) the IVT-only capable center and (2) the IVT and EVT-capable center. They were also asked about the thrombolytic agent of choice in current and ideal circumstances for these settings.

Results: A total of 203 physicians (42.9% vascular neurologists) from 44 countries completed the survey. Most participants (55.2%) spent ≥50% of their time delivering stroke care. The survey results showed that in current practice, more than 90% of respondents would offer IVT + EVT to patients with LVO stroke presenting to either an EVT-capable (91.1%) or IVT-only-capable center (93.6%). Although nearly 80% currently use alteplase for thrombolysis, around 60% would ideally like to switch to tenecteplase independent of the practice setting. These results were similar between stroke and non-stroke neurologists.

Discussion: Most physicians prefer IVT before EVT in patients with acute ischemic stroke attributable to large vessel occlusion independent of the practice setting.

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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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