预测美国人群接受脑出血微创手术清除的资格。

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-09-17 DOI:10.1161/STROKEAHA.125.052998

Paul M Wechsler, Heidi Sucharew, David J Robinson, Robert J Stanton, Yasmin N Aziz, Charles Prestigiacomo, Stacie L Demel, Paul Horn, Thomas C Maloney, Brady J Williamson, Lily Wang, Vivek J Khandwala, Shantala Gangatirkar, Mary Gaskill-Shipley, Mary Haverbusch, Thomas Tomsick, David Wang, Rebecca S Cornelius, Daniel Woo, Joseph P Broderick, Dawn O Kleindorfer, Brett M Kissela, Matthew L Flaherty, Eva A Mistry, Achala Vagal, Pooja Khatri

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引用次数: 0

摘要

背景：在富集试验（早期微创切除脑出血）中，微创手术引流改善了急性自发性大叶性脑出血（ICH）患者的预后。在一项基于美国人群的研究中，我们确定了适合微创手术疏散的脑出血患者的百分比，并预测了2020年美国每年适合这种治疗的脑出血患者数量。方法：我们确定成人（年龄≥18岁）具有急性(国际疾病分类代码，临床资料摘要，并由医生判定。脑出血的位置和体积由神经放射科医师集中判定。我们应用了ENRICH试验标准来计算符合微创手术切除条件的(1)所有部位脑出血和(2)大叶脑出血患者的保守和自由估计百分比。我们使用2020年美国人口普查数据外推了2020年美国成年人口的估计。结果：2015年，我们在大辛辛那提/北肯塔基州确定了196例急性自发性脑出血患者。应用所有标准后，2.0% （n=5）的急性脑出血患者（5.1%;n=5）符合微创手术抽吸条件。最常见的排除标准是ICH卷1（52%）。在自由估计中，所有急性脑出血患者中有2.6% - 3.6% (n=4-7)（大叶性脑出血患者中4.1%-7.1%）符合条件。我们预计，到2020年，美国估计72 283例成年脑出血患者中有1066 - 1848例患者符合资格标准。结论：在我们的人群中，大约有2%到4%的脑出血患者符合微创手术撤离的条件，根据ENRICH标准，美国每年有1066到1848例脑出血患者。未来的研究需要确定脑出血手术治疗的适应症是否可以扩大。

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Projecting US Population Eligibility for Minimally Invasive Surgical Evacuation of Intracerebral Hemorrhage.

Background: Minimally invasive surgical evacuation improved outcomes for patients with acute, spontaneous, lobar intracerebral hemorrhage (ICH) in the ENRICH trial (Early Minimally Invasive Removal of ICH). We determined the percentage of patients with ICH in a US population-based study eligible for minimally invasive surgical evacuation and projected the annual number of patients with ICH in the United States in 2020 eligible for this therapy.

Methods: We ascertained adults (aged ≥18 years) with acute (<24 hours from last known well), spontaneous ICH in Greater Cincinnati/Northern Kentucky in 2015. Cases were identified by the International Classification of Diseases codes, clinical data abstracted, and physician adjudicated. Location and volume of ICH were centrally adjudicated by neuroradiologists. We applied ENRICH trial criteria to calculate conservative and liberal estimates of the percentage of patients with (1) all ICH at any location and (2) lobar ICH eligible for minimally invasive surgical evacuation. We extrapolated our estimates to the 2020 US adult population using 2020 US census data.

Results: We identified 196 patients in Greater Cincinnati/Northern Kentucky in 2015 with acute, spontaneous ICH. After applying all criteria, 2.0% (n=5) of all patients with acute ICH (5.1%; n=5 lobar ICH) were eligible for minimally invasive surgical evacuation. The most common exclusion criteria were ICH volume <30 mL (60%) and prestroke modified Rankin Scale score >1 (52%). In liberal estimates, 2.6% to 3.6% (n=4-7) of all patients with acute ICH (4.1%-7.1% of lobar ICH) were eligible. We projected 1066 to 1848 patients of an estimated 72 283 adult patients with ICH in the United States in 2020 met eligibility criteria.

Conclusions: Approximately 2% to 4% of patients with ICH in our population were eligible for minimally invasive surgical evacuation based on ENRICH criteria, which extrapolates to 1066 to 1848 patients with ICH in the United States annually. Future research is needed to determine whether indications for effective surgical therapy for ICH can be expanded.

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.