目的探讨逆向半回收技术(RESET)治疗颅内急性大血管闭塞患者的短期疗效。方法回顾性分析2017年11月—2019年3月前瞻性收集的天津市环湖医院使用RESET行机械取栓的286例颅内急性大血管闭塞患者的临床资料。其中男性188例,女性98例,年龄18...目的探讨逆向半回收技术(RESET)治疗颅内急性大血管闭塞患者的短期疗效。方法回顾性分析2017年11月—2019年3月前瞻性收集的天津市环湖医院使用RESET行机械取栓的286例颅内急性大血管闭塞患者的临床资料。其中男性188例,女性98例,年龄18~84岁。根据是否存在颅内动脉粥样硬化性狭窄(ICAS)将患者分为ICAS组186例(65%)、非ICAS组100例(35%)。观察并比较两组患者分别接受RESET取栓后的术后即刻改良脑梗死溶栓(mTICI)分级、穿刺-再通时间、取栓次数、并发症及术后90 d改良Rankin量表(mRS)评分等,以评价短期疗效。结果两组患者的年龄、性别、既往史、入院美国国立卫生研究院中风量表(NIHSS)评分、Alberta卒中项目早期CT(ASPECT)评分等基线资料比较差异均无统计学意义(P>0.05)。286例患者中272例(95.1%)患者实现血管再通成功(95.1%),其中1次取栓实现完全再通209例(73.1%),33例(11.5%)患者取栓后实施了补救性治疗。ICAS组因术后症状性颅内出血死亡2例,非ICAS组因术后多脏器功能衰竭死亡1例。两组患者比较,ICAS组穿刺-再通时间长于非ICAS组[141.36(124.11,156.53)min vs.65.17(53.92,83.25)min,P<0.001],取栓次数低于非ICAS组[1.00(1.00,1.00)vs.1.00(1.00,2.00),P=0.002],差异均有统计学意义(P<0.05)。两组患者最终再通率、1次取栓后完全再通率、远端栓塞或新发部位栓塞及症状性颅内出血、围术期死亡、术后90 d mRS评分等差异均无统计学意义(P>0.05)。结论RESET治疗颅内急性大血管闭塞的短期疗效满意,ICAS组患者再通需要的取栓次数明显低于非ICAS组,该方法尤其适用于合并ICAS的患者。展开更多
国际联校教育竞赛与评价项目(International Competitions and Assessment for Schools,简称ICAS)是由澳大利亚新南威尔士大学下属的澳大利亚学校教育评估部开发并实施的国际性中小学教育评估项目,地位相当于澳大利亚全国中小学的统一...国际联校教育竞赛与评价项目(International Competitions and Assessment for Schools,简称ICAS)是由澳大利亚新南威尔士大学下属的澳大利亚学校教育评估部开发并实施的国际性中小学教育评估项目,地位相当于澳大利亚全国中小学的统一水平考试。展开更多
Aim:To review the selection of treatment methods for symptomatic intracranial atherosclerotic stenosis(sICAS)in the acute phase and the progress of research on sICAS interventional therapy based on the latest research...Aim:To review the selection of treatment methods for symptomatic intracranial atherosclerotic stenosis(sICAS)in the acute phase and the progress of research on sICAS interventional therapy based on the latest research technology development.Intracranial atherosclerotic stenosis(ICAS)is the most common cause of ischemic stroke in our country.Currently,treatment is primarily based on pharmacotherapy.In recent years,with the changes and development of endovascular treatment techniques,materials,and treatment concepts,many new research findings have emerged.This article will review the selection of treatment methods for symptomatic intracranial atherosclerotic stenosis(sICAS)in the acute phase and the progress of research on sICAS interventional therapy based on the latest research technology development.展开更多
Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This ...Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.展开更多
文摘目的探讨逆向半回收技术(RESET)治疗颅内急性大血管闭塞患者的短期疗效。方法回顾性分析2017年11月—2019年3月前瞻性收集的天津市环湖医院使用RESET行机械取栓的286例颅内急性大血管闭塞患者的临床资料。其中男性188例,女性98例,年龄18~84岁。根据是否存在颅内动脉粥样硬化性狭窄(ICAS)将患者分为ICAS组186例(65%)、非ICAS组100例(35%)。观察并比较两组患者分别接受RESET取栓后的术后即刻改良脑梗死溶栓(mTICI)分级、穿刺-再通时间、取栓次数、并发症及术后90 d改良Rankin量表(mRS)评分等,以评价短期疗效。结果两组患者的年龄、性别、既往史、入院美国国立卫生研究院中风量表(NIHSS)评分、Alberta卒中项目早期CT(ASPECT)评分等基线资料比较差异均无统计学意义(P>0.05)。286例患者中272例(95.1%)患者实现血管再通成功(95.1%),其中1次取栓实现完全再通209例(73.1%),33例(11.5%)患者取栓后实施了补救性治疗。ICAS组因术后症状性颅内出血死亡2例,非ICAS组因术后多脏器功能衰竭死亡1例。两组患者比较,ICAS组穿刺-再通时间长于非ICAS组[141.36(124.11,156.53)min vs.65.17(53.92,83.25)min,P<0.001],取栓次数低于非ICAS组[1.00(1.00,1.00)vs.1.00(1.00,2.00),P=0.002],差异均有统计学意义(P<0.05)。两组患者最终再通率、1次取栓后完全再通率、远端栓塞或新发部位栓塞及症状性颅内出血、围术期死亡、术后90 d mRS评分等差异均无统计学意义(P>0.05)。结论RESET治疗颅内急性大血管闭塞的短期疗效满意,ICAS组患者再通需要的取栓次数明显低于非ICAS组,该方法尤其适用于合并ICAS的患者。
文摘Aim:To review the selection of treatment methods for symptomatic intracranial atherosclerotic stenosis(sICAS)in the acute phase and the progress of research on sICAS interventional therapy based on the latest research technology development.Intracranial atherosclerotic stenosis(ICAS)is the most common cause of ischemic stroke in our country.Currently,treatment is primarily based on pharmacotherapy.In recent years,with the changes and development of endovascular treatment techniques,materials,and treatment concepts,many new research findings have emerged.This article will review the selection of treatment methods for symptomatic intracranial atherosclerotic stenosis(sICAS)in the acute phase and the progress of research on sICAS interventional therapy based on the latest research technology development.
基金Beijing Hospitals Authority’s Ascent Plan(DFL20220702)National Natural Science Foundation of China(82101398).
文摘Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.
