当前位置: X-MOL 学术BMC Neurol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study.
BMC Neurology ( IF 2.6 ) Pub Date : 2020-03-05 , DOI: 10.1186/s12883-020-01653-z
Milani Deb-Chatterji 1 , Hans Pinnschmidt 2 , Fabian Flottmann 3 , Hannes Leischner 3 , Anna Alegiani 1 , Caspar Brekenfeld 3 , Jens Fiehler 3 , Christian Gerloff 1 , Götz Thomalla 1
Affiliation  

Randomized controlled trials (RCTs) demonstrated efficacy and safety of endovascular treatment (ET) in anterior circulation large vessel occlusions (LVO). We aimed at investigating how stroke patients treated by thrombectomy in clinical practice and their outcome compare to cohorts and results of thrombectomy trials. In a prospective study, we consecutively included stroke patients treated by thrombectomy (2015–2017). Baseline characteristics, procedural and outcome data were analyzed. Outcome was assessed by modified Rankin Scale (mRS) at 90 days. Ordinal regression analysis was performed to identify predictors of outcome. Thrombectomy was applied in 264 patients (median 75 years, 49.6% female). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16, 58.0% received concomitant intravenous thrombolysis, 62.1% were referred from external hospitals. Median Alberta Stroke Program Early CT Score (ASPECTS) was 7. Successful recanalization (modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) was achieved in 72.0%. Symptomatic intracranial hemorrhage (sICH) occurred in 4.5%. Independent outcome (mRS 0–2) was achieved in 26.2%, poor outcome (mRS 5–6) in 49.2%. Only 33.5% met the stringent enrolment criteria of previous RCTs. Lower age, baseline NIHSS, pre-stroke mRS, higher ASPECTS, and successful recanalization were independent predictors of favourable outcome. The majority of stroke patients treated by ET in clinical practice would not have qualified for randomization in prior RCTs. Outcome in real-life patient cohorts is worse than in the highly selected cohorts from randomized trials, while rates of successful recanalization, sICH and outcome predictors are the same. Our findings support ET in broader patient populations than in the RCTs and may improve treatment decision in individual stroke patients with LVO in clinical practice.

中文翻译:

在现实生活中,通过血栓切除术治疗的中风患者与临床试验的人群不同:前瞻性观察性研究。

随机对照试验(RCT)证明了血管内治疗(ET)在前循环大血管闭塞(LVO)中的有效性和安全性。我们旨在调查在临床实践中通过血栓切除术治疗的中风患者及其结局与血栓切除术试验的队列和结果相比如何。在一项前瞻性研究中,我们连续纳入了通过血栓切除术治疗的中风患者(2015-2017年)。分析基线特征,程序和结果数据。在90天时通过改良的Rankin量表(mRS)评估结果。进行了序贯回归分析以鉴定结果的预测因子。264名患者接受了血栓切除术(中位年龄75岁,女性49.6%)。美国国立卫生研究院卒中量表(NIHSS)的中位数为16,其中58.0%的患者同时接受了静脉溶栓治疗62。1%来自外部医院。艾伯塔省卒中计划早期CT评分(ASPECTS)中位数为7。成功的再通(改良脑梗死溶栓评分,mTICI 2b / 3)达到72.0%。有症状的颅内出血(sICH)发生率为4.5%。独立结果(mRS 0–2)达到26.2%,不良结果(mRS 5–6)达到49.2%。只有33.5%的人符合以前RCT的严格入学标准。较低的年龄,基线NIHSS,中风前mRS,较高的ASPECTS和成功的再通血是预后良好的独立预测因素。在临床实践中,大多数接受ET治疗的中风患者在先前的RCT中没有资格获得随机分组。现实生活中的患者队列的结果要比随机试验中经过高度筛选的队列患者的结果差,而再通的成功率,sICH和结果预测因子相同。我们的研究结果支持比RCT更广泛的患者人群进行ET,并可能在临床实践中改善LVO个体卒中患者的治疗决策。
更新日期:2020-03-06
down
wechat
bug