{"title":"脑小血管疾病与急性缺血性卒中的院前延误有关。","authors":"Marina Masui, Takeo Sato, Motohiro Okumura, Takahiro Ishikawa, Kenichi Sakuta, Tatsushi Kokubu, Junichiro Takahashi, Tomomichi Kitagawa, Maki Tanabe, Asako Onda, Teppei Komatsu, Kenichiro Sakai, Tadashi Umehara, Hidetaka Mitsumura, Yasuyuki Iguchi","doi":"10.5551/jat.64968","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.</p><p><strong>Methods: </strong>Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.</p><p><strong>Results: </strong>Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01-1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05-1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p=0.001).</p><p><strong>Conclusions: </strong>Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke.\",\"authors\":\"Marina Masui, Takeo Sato, Motohiro Okumura, Takahiro Ishikawa, Kenichi Sakuta, Tatsushi Kokubu, Junichiro Takahashi, Tomomichi Kitagawa, Maki Tanabe, Asako Onda, Teppei Komatsu, Kenichiro Sakai, Tadashi Umehara, Hidetaka Mitsumura, Yasuyuki Iguchi\",\"doi\":\"10.5551/jat.64968\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.</p><p><strong>Methods: </strong>Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.</p><p><strong>Results: </strong>Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01-1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05-1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p=0.001).</p><p><strong>Conclusions: </strong>Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.</p>\",\"PeriodicalId\":15128,\"journal\":{\"name\":\"Journal of atherosclerosis and thrombosis\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of atherosclerosis and thrombosis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5551/jat.64968\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of atherosclerosis and thrombosis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5551/jat.64968","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的：确定脑小血管疾病（SVD）的严重程度是否与急性缺血性卒中的院前延误有关：本研究纳入了连续的缺血性脑卒中患者。我们使用 SVD 总分评估 SVD 负担。患者分为两组：从发病到到达医院的时间在 4.5 小时之内（早期到达组）和从发病到到达医院的时间超过 4.5 小时（延迟到达组）。首先，我们使用逻辑回归分析评估了 SVD 总分是否与院前延误有关。其次，我们评估了得分中与延误独立相关的项目。最后，我们确定该项目是否与延误呈线性关系：在 2,112 名接受筛查的患者中，1,754 人被纳入研究（1,253 名男性[71%]；中位年龄 69 岁）。延迟到达组有 1,105 名患者（63%）。SVD 总分与延误有独立关联（OR 1.11，95% CI 1.01-1.21，P=0.025）。在该评分的 4 个项目中，只有基底节血管周围间隙增大（EPVS）与延迟独立相关（OR 1.37，95% CI 1.05-1.80，p=0.022）。EPVS等级与延迟之间呈线性趋势，参考EPVS等级0-1（EPVS等级2：OR 1.22，95% CI 0.92-1.62，p=0.170；EPVS等级3：OR 1.69，95% CI 1.20-2.38，p=0.002；EPVS等级4：OR 2.17，95% CI 1.37-3.44，p=0.001）：急性缺血性卒中的院前延迟可能与 SVD 的严重程度有关，尤其是基底节的 EPVS。
Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke.
Aim: To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.
Methods: Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.
Results: Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01-1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05-1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p=0.001).
Conclusions: Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.
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