静脉溶栓治疗急性缺血性脑卒中合并烟雾病患者的疗效和安全性。

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-02-11 Epub Date: 2025-01-07 DOI:10.1212/WNL.0000000000210243

Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi

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引用次数: 0

摘要

目的：烟雾病是一种罕见的脑血管疾病，是众所周知的急性缺血性脑卒中（AIS）的危险因素。虽然静脉溶栓（IVT）是AIS患者的既定治疗方法，但其对烟雾病患者的疗效和安全性在很大程度上尚不清楚。方法：这是对美国2016-2021年全国再入院数据库的大型回顾性分析。纳入了伴有AIS的烟雾病患者。接受搭桥手术的患者被排除在外。倾向评分匹配（PSM）将IVT患者与保守治疗的类似患者进行匹配。主要疗效指标为常规出院回家自理。安全性结局包括颅内出血（ICH）和住院死亡率。结果：共有3050例烟雾病患者合并AIS，其中214例（7.0%）接受了IVT治疗。PSM后，IVT患者的常规出院率高于未接受IVT治疗的患者（分别为53.6%对45.1%,p = 0.045）。与非IVT治疗相比，IVT治疗与不同的ICH发生率（7.1% vs 10.9%, p = 0.58）或住院死亡率（3.8% vs 5.3%, p = 0.93）无关。讨论：IVT很少用于治疗烟雾病患者的AIS，对于特定病例可能是有效和安全的。需要前瞻性研究的证实。

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Efficacy and Safety of IV Thrombolysis for Acute Ischemic Stroke Patients With Moyamoya Disease.

Objectives: Moyamoya disease (MMD) is a rare cerebrovascular condition, and it is a well-known risk factor of acute ischemic stroke (AIS). While IV thrombolysis (IVT) is an established treatment for patients with AIS, its efficacy and safety for patients with MMD is largely unknown.

Methods: This was a large retrospective analysis of the 2016-2021 Nationwide Readmissions Database in the United States. MMD patients with AIS were included. Patients who underwent bypass surgery were excluded. Propensity score matching (PSM) was performed to match IVT patients with similar patients who were managed conservatively. The primary efficacy outcome was routine discharge to home with self-care. Safety outcomes included intracranial hemorrhage (ICH) and in-hospital mortality.

Results: A total of 3,050 MMD patients with AIS were identified, of whom 214 (7.0%) were treated with IVT. After PSM, IVT patients had higher rates of routine discharge compared with those who were not treated with IVT (53.6% vs 45.1%, respectively, p = 0.045). IVT treatment, compared with no-IVT, was not associated with different rates of ICH (7.1% vs 10.9%, p = 0.58) or in-hospital mortality (3.8% vs 5.3%, p = 0.93).

Discussion: IVT is seldom used to treat AIS in patients with MMD, and it may be effective and safe for select cases. Confirmation with prospective studies is needed.

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.