病请描述：确定有效测试神经保护药物的目标人群摘要背景和目的：我们的目的是利用基线结果预测因子来确定受益于潜在神经保护药物的可能性更高的急性缺血性卒中患者亚组，并测试不同的选择标准策略是否可以提高检测到的治疗效果。方法：我们分析了接受血管内治疗的急性脑卒中患者出院/第5天时，24-72小时计算机断层扫描测量的最终梗死体积（FIV）与美国国立卫生研究院卒中量表之间的关系。模型根据年龄、性别和受累半球进行调整。我们分析了美国国立卫生研究院卒中量表中绝对（5-15ml）和相对（33%）FIV降低对整个人群以及根据CT灌注成像基线标准选择的不同亚组患者的影响。结果：我们分析了627例患者，FIV与5天美国国立卫生研究院卒中量表之间的相关性最好用二次函数来描述，在调整分析中回归系数β=1.56（[95%CI，1.45-1.67]P<0.001）。在考虑固定绝对（5/15ml）FIV降低的模型中，排除预测FIV较大的患者时，治疗效果最高，而在33%FIV降低模型中，排除预期良好结果的患者时，治疗效果增加。结论：在脑卒中神经保护药物试验中，无论是血管内血栓切除术后疗效良好的患者还是大面积梗死的患者，都可能会降低治疗效果。入院时的计算机断层扫描灌注有助于根据预期的药物效果选择合适的患者。Stroke. 2021 Jan;52(2):505-510. doi: 10.1161/STROKEAHA.120.032025. Epub 2021 Jan 11.Defining a Target Population to Effectively Test a Neuroprotective DrugMarta Olivé-Gadea 1 2, Manuel Requena 1 2, Daniel Campos 1 2, Alvaro Garcia-Tornel 1 2, Matías Deck 1 2, Marian Muchada 1 2, Sandra Boned 1 2, Noelia Rodríguez 1 2, Jesús Juega 1 2, David Rodríguez-Luna 1 2, Jorge Pagola 1 2, Marta Rubiera 1 2, Macarena Hernández-Jiménez 3, Carlos A Molina 1 2, Marc Ribo 1 2Affiliations collapseAffiliations1Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).2Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).3Apta Targets, Madrid, Spain (M.H.-J.).PMID: 33423513 DOI: 10.1161/STROKEAHA.120.032025AbstractBackground and purpose: We aim to identify the subgroup of acute ischemic stroke patients with higher probabilities of benefiting from a potential neuroprotective drug using baseline outcome predictors and test whether different selection criteria strategies can improve detected treatment effect.Methods: We analyzed the association between final infarct volume (FIV), measured on 24- to 72-hour computed tomography, and National Institutes of Health Stroke Scale at discharge/day 5 of acute stroke patients who underwent endovascular treatment. Models were adjusted for age, sex, and affected hemisphere. We analyzed the impact of absolute (5-15 mL) and relative (33%) FIV reductions in the National Institutes of Health Stroke Scale in the whole population and in different subsets of patients selected according to baseline imaging criteria using computed tomography perfusion.Results: We analyzed 627 patients; association between FIV and 5-day National Institutes of Health Stroke Scale was best described with a quadratic function, with a regression coefficient β=1.56 ([95% CI, 1.45-1.67] P<0.001) in the adjusted analysis. In the models considering a fixed absolute (5/15 mL) FIV reduction, treatment effect was highest when patients with predicted larger FIV were excluded, whereas in a 33% FIV reduction model, treatment effect increased with the exclusion of patients with expected excellent outcomes.Conclusions: Patients either with excellent outcomes after endovascular thrombectomy or with large infarcts may dilute the treatment effect in stroke neuroprotective drug trials. Computed tomography perfusion on admission may help selecting adequate patients according to expected drug effect profile.Keywords: infarction; ischemia; neuroprotection; patient selection; probability.
刘建仁 2021-03-18阅读量9260
病请描述：脑卒中患者转院接受血管内治疗时重复显像的价值劳拉·C·范·米宁1号，内利亚·阿拉特·泰瑞罗斯23号，阿德里安·E·格罗特1号，马农·卡佩尔霍夫3号，卢多·F·M·比宁3号，亨克·A·马克林23号，巴特·J·埃默3号，伊沃·B·W·E·M·鲁斯1号，查尔斯·B·L·M·马约伊3号，乔纳森·M·库蒂尼奥4号从属关系PMID:33685983 DOI:10.1136/neurintsurg-2020-017050摘要背景：被转移到综合性卒中中心进行血管内治疗（EVT）的卒中患者在EVT前经常进行重复的神经影像学检查。目的：评价重复成像的成功率及其对治疗次数的影响。方法：我们纳入了2016-2019年由主要卒中中心转诊到我院进行EVT的大血管闭塞（LVO）卒中成年患者。我们排除了那些因为一次成像不可用、不完整或质量不高而重复成像的患者。结果包括治疗时间和重复的影像学表现。结果：在677例转移性LVO卒中中，551例被纳入。在165/551例（30%）患者中重复成像，主要是因为临床改善（86/165（52%）或恶化（40/165（24%）。重复显像的患者门到腹股沟的时间比未重复显像的患者高（中位数43 vs 27 min，校正时差：20 min，95%可信区间15~25）。在因临床症状改善而重复造影的患者中，50/86（58%）的LVO已消退。在临床病情恶化的患者中，重复成像导致3/40（8%）患者无法进行EVT。无症状性颅内出血。最终，75/165（45%）的重复成像患者接受了EVT，而326/386（84%）的无重复成像患者接受了EVT（p<0.01）。结论：30%的LVO卒中患者重复进行神经影像学检查，导致中位治疗延迟20分钟。在临床病情恶化的患者中，没有检测到sICH，重复成像很少改变EVT的适应证。然而，在超过一半的临床改善患者中，LVO已经消失，导致EVT的放弃。关键词：CT；脑卒中；血栓切除术。Background: Predictive maps of the final infarct may help therapeutic decisions in acute ischemic stroke patients. Our objectives were to assess whether integrating the reperfusion status into deep learning models would improve their performance, and to compare them to current clinical prediction methods.Methods: We trained and tested convolutional neural networks (CNNs) to predict the final infarct in acute ischemic stroke patients treated by thrombectomy in our center. When training the CNNs, non-reperfused patients from a non-thrombectomized cohort were added to the training set to increase the size of this group. Baseline diffusion and perfusion-weighted magnetic resonance imaging (MRI) were used as inputs, and the lesion segmented on day-6 MRI served as the ground truth for the final infarct. The cohort was dichotomized into two subsets, reperfused and non-reperfused patients, from which reperfusion status specific CNNs were developed and compared to one another, and to the clinically-used perfusion-diffusion mismatch model. Evaluation metrics included the Dice similarity coefficient (DSC), precision, recall, volumetric similarity, Hausdorff distance and area-under-the-curve (AUC).Results: We analyzed 109 patients, including 35 without reperfusion. The highest DSC were achieved in both reperfused and non-reperfused patients (DSC = 0.44 ± 0.25 and 0.47 ± 0.17, respectively) when using the corresponding reperfusion status-specific CNN. CNN-based models achieved higher DSC and AUC values compared to those of perfusion-diffusion mismatch models (reperfused patients: AUC = 0.87 ± 0.13 vs 0.79 ± 0.17, P < 0.001; non-reperfused patients: AUC = 0.81 ± 0.13 vs 0.73 ± 0.14, P < 0.01, in CNN vs perfusion-diffusion mismatch models, respectively).Conclusion: The performance of deep learning models improved when the reperfusion status was incorporated in their training. CNN-based models outperformed the clinically-used perfusion-diffusion mismatch model. Comparing the predicted infarct in case of successful vs failed reperfusion may help in estimating the treatment effect and guiding therapeutic decisions in selected patients.
刘建仁 2021-03-16阅读量9215
病请描述：DEFUSE3研究中中风发作后24小时内持续性靶点失配情况瑟伦·克里斯滕森1号、迈克尔·姆林纳什1号、斯蒂芬妮·肯普1号、阿玛纳特·延努1号、杰里米·J·海特2号、迈克尔·P·马克2号、马丁·G·兰斯堡1号、格雷戈里·W·阿尔伯斯1号隶属关系扩大PMID:30735466 DOI:10.1161/STROKEAHA.118.023392摘要背景和目的-血管内血栓切除术的有效性已被证实，在脑卒中发病后24小时内，患者选择灌注成像。我们假设一些患者在发病后24小时内存在持续良好的灌注曲线，并且可以通过较低的基线低灌注强度比来预测，这表明侧支循环良好。方法：我们从DEFUSE 3试验（缺血性卒中影像学评价后的血管内治疗）中确定对照组患者，随机分组后24小时进行弥散加权成像和灌注磁共振成像，并比较持续失配患者的影像学和临床变量与随机化后24小时不再出现不匹配的患者相比。结果-18%的对照组患者在最后一次已知的健康时间后>38小时有持续良好的外形。这些患者的基线弥散加权成像和Tmax>6秒容积与最初良好灌注曲线变得不利的患者相似（弥散加权成像病灶7 vs 17 mL；P=0.17，Tmax>6秒98 vs 100 mL；P=0.48），但梗死生长较少（15 vs 59 mL；P<0.001），随机分组后24小时梗死体积缩小3倍（15对59 mL；P<0.001）。持续良好灌注的患者在基线成像时低灌注强度比率显著降低（0.2比0.4；P<0.01）。只有10%的持续失配患者在90天时出现了良好的临床结果。结论：约20%的大脑中动脉或颈内动脉闭塞患者在延长的时间窗内出现，且未接受血栓切除术治疗，其持续失配至少持续24小时。这些患者在出现时具有良好的低灌注强度比，可能出现延迟性梗死扩大，临床预后较差。需要进行临床试验，以确定灌注情况良好的患者是否能从24小时后的再灌注中获益。临床试验注册-网址：https://www.clinicaltrials.gov。唯一标识符：NCT02586415。Stroke. 2019 Mar;50(3):754-757. doi: 10.1161/STROKEAHA.118.023392.Persistent Target Mismatch Profile >24 Hours After Stroke Onset in DEFUSE 3Søren Christensen 1, Michael Mlynash 1, Stephanie Kemp 1, Amarnath Yennu 1, Jeremy J Heit 2, Michael P Marks 2, Maarten G Lansberg 1, Gregory W Albers 1Affiliations expandPMID: 30735466 DOI: 10.1161/STROKEAHA.118.023392AbstractBackground and Purpose- Efficacy of endovascular thrombectomy has been demonstrated up to 24 hours after stroke onset in patients selected with perfusion imaging. We hypothesized that a persistent favorable perfusion profile exists in some patients beyond 24 hours from the onset and can be predicted by a lower baseline hypoperfusion intensity ratio, which indicates favorable collaterals. Methods- We identified control arm patients from the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) with a diffusion weighted imaging and perfusion magnetic resonance imaging performed 24 hours following randomization and compared imaging and clinical variables between patients with persistent mismatch versus patients who no longer had a mismatch 24 hours after randomization. Results- Eighteen percent of the control arm patients had a persistent favorable profile >38 hours after last known well time. These patients had similar baseline diffusion weighted imaging and Tmax >6 seconds volumes as patients whose initially favorable perfusion profile became unfavorable (diffusion weighted imaging lesion 7 versus 17 mL; P=0.17, Tmax >6 seconds 98 versus 100 mL; P=0.48) yet experienced less infarct growth (15 versus 59 mL; P<0.001) and had 3-fold smaller infarct volumes (15 versus 59 mL; P<0.001) 24 hours after randomization. Patients with a persistent favorable perfusion profile had a significantly lower hypoperfusion intensity ratio on baseline imaging (0.2 versus 0.4; P<0.01). Favorable clinical outcome at 90 days occurred in only 10% of the persistent mismatch patients. Conclusions- About 20% of patients with a middle cerebral artery or internal carotid artery occlusion who present in an extended time window and are not treated with thrombectomy have a persistent mismatch for at least an additional 24 hours. These patients have a favorable hypoperfusion intensity ratio at presentation, may experience delayed infarct expansion, and have poor clinical outcomes. Clinical trials are needed to determine if patients with a favorable perfusion profile benefit from reperfusion beyond 24 hours. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.
刘建仁 2021-03-14阅读量9325
病请描述：急性缺血性中风患者的重症监护入院和管理：欧洲重症监护医学会的横断面调查摘要背景：关于危重病急性缺血性中风（AIS）患者的重症监护治疗，目前尚无具体的建议，关于该人群的最佳通气、血流动力学和普通重症监护室（ICU）治疗目标仍存在问题。我们进行了一项国际调查，以调查AIS患者的ICU入院标准和管理。方法：2019年11月1日至2020年3月30日期间，欧洲重症监护医学会网站上提供了一份电子问卷，包括25个项目，分为3个部分，并通过神经重症监护（NIC）部分时事通讯进行宣传。这项调查通过电子邮件直接发送给NIC成员，并得到了欧洲重症监护医学会的认可。结果：198个中心共有214名被调查者，应答率为16.5%（214/1296）。在大多数中心（67%），2019年入住受访医院的AIS患者人数在100至300人之间，其中每家医院需要入住ICU的患者不到50人。最广泛接受的ICU入院标准指征是插管和机械通气。88（58%）的受访者使用了动脉血压（ABP）管理的标准方案。对于符合静脉溶栓条件的患者，最常见的ABP靶点是<185/110 mm Hg（n=77[51%]），而对于接受机械血栓切除术的患者，ABP靶点是≤160/90 mm Hg（n=79[54%]）。降低ABP的首选药物是拉贝洛尔（n=84[55.6%]）。其他常用的治疗靶点包括：血糖140~180mg/dL（n=65[43%]），大多数机构通过静脉胰岛素输注维持（n=110[72.4%]）；中风发作后2~3天内开始肠内喂养（n=142[93.4%]）；血氧饱和度（SpO2）>95%（n=80[53%]），潮气量为预测体重的6至8 mL/kg（n=135[89%]）。结论：AIS的ICU管理，包括治疗目标和临床实践策略，在不同的中心有重要差异。我们的研究结果可能有助于确定未来的研究和建立一个关于AIS患者ICU治疗目标的研究议程。J Neurosurg Anesthesiol. 2021 Feb 9. doi: 10.1097/ANA.0000000000000761. Online ahead of print.Intensive Care Admission and Management of Patients With Acute Ischemic Stroke: A Cross-sectional Survey of the European Society of Intensive Care MedicineChiara Robba 1, Martina Giovannini, Geert Meyfroidt, Mathieu van der Jagt, Giuseppe Citerio, Martin Smith, CollaboratorsAffiliations expandPMID: 33587531 DOI: 10.1097/ANA.0000000000000761AbstractBackground: No specific recommendations are available regarding the intensive care management of critically ill acute ischemic stroke (AIS) patients, and questions remain regarding optimal ventilatory, hemodynamic, and general intensive care unit (ICU) therapeutic targets in this population. We performed an international survey to investigate ICU admission criteria and management of AIS patients.Methods: An electronic questionnaire including 25 items divided into 3 sections was available on the European Society of Intensive Care Medicine Web site between November 1, 2019 and March 30, 2020 and advertised through the neurointensive care (NIC) section newsletter. This survey was emailed directly to the NIC members and was endorsed by the European Society of Intensive Care Medicine.Results: There were 214 respondents from 198 centers, with response rate of 16.5% of total membership (214/1296). In most centers (67%), the number of AIS patients admitted to respondents' hospitals in 2019 was between 100 and 300, and, among them, fewer than 50 required ICU admission per hospital. The most widely accepted indication for ICU admission criteria was a requirement for intubation and mechanical ventilation. A standard protocol for arterial blood pressure (ABP) management was utilized by 88 (58%) of the respondents. For patients eligible for intravenous thrombolysis, the most common ABP target was <185/110 mm Hg (n=77 [51%]), whereas for patients undergoing mechanical thrombectomy it was ≤160/90 mm Hg (n=79 [54%]). The preferred drug for reducing ABP was labetalol (n=84 [55.6%]). Other frequently used therapeutic targets included: blood glucose 140 to 180 mg/dL (n=65 [43%]) maintained with intravenous insulin infusion in most institutions (n=110 [72.4%]); enteral feeding initiated within 2 to 3 days from stroke onset (n=142 [93.4%]); oxygen saturation (SpO2) >95% (n=80 [53%]), and tidal volume 6 to 8 mL/kg of predicted body weight (n=135 [89%]).Conclusions: The ICU management of AIS, including therapeutic targets and clinical practice strategies, importantly varies between centers. Our findings may be helpful to define future studies and create a research agenda regarding the ICU therapeutic targets for AIS patients.
刘建仁 2021-03-14阅读量1.1万
病请描述：在4.5到9小时内静脉溶栓是否会增加血栓的迁移，导致血管内取栓无法开展？摘要背景和目的：急性缺血性卒中患者静脉溶栓（IVT）后，远端血栓迁移是公认的事件。值得注意的是，最初通过血管内血栓切除术可以恢复的血栓可能会转移到远端不可恢复的位置，影响临床结果。我们调查了在4.5到9小时的时间窗内，静脉血栓移植后血栓迁移导致血栓不可接近的发生率。方法：我们对EXTEND试验（延长急诊神经功能缺损溶栓时间）的资料进行回顾性分析。根据CT血管造影或磁共振血管造影确定基线和12-24小时随访的血栓位置。两个治疗组（IVT组和安慰剂组）之间确定并比较了导致从可恢复到不可恢复位置变化的血栓迁移发生率。结果：共评估220例患者。37例患者发生了血栓从可恢复部位向不可恢复部位的转移：安慰剂组21例（19.3%），IVT组16例（14.4%）。两组之间血栓迁移率无显著差异（P=0.336）。结论：我们的研究结果没有显示在接受IVT治疗的患者中，血栓迁移增加导致无法取栓。Stroke. 2021 Mar;52(3):1083-1086. doi: 10.1161/STROKEAHA.120.030661. Epub 2021 Feb 16.Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?Jeremy C Lim 1, Leonid Churilov 2, Andrew Bivard 3, Henry Ma 3, Richard J Dowling 1, Bruce C V Campbell 3, Mark W Parsons 3, Stephen M Davis 3, Geoffrey A Donnan 3, Peter J Mitchell 1, Bernard Yan 3Affiliations expandPMID: 33588590 DOI: 10.1161/STROKEAHA.120.030661AbstractBackground and purpose: Distal clot migration is a recognized event following intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. Of note, clots that were initially retrievable by endovascular thrombectomy may migrate to a distal nonretrievable location and compromise clinical outcome. We investigated the incidence of clot migration leading to clot inaccessibility following IVT in the time window of 4.5 to 9 hours.Methods: We performed a retrospective analysis of the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits) data. Baseline and 12- to 24-hour follow-up clot location was determined on computed tomography angiogram or magnetic resonance angiogram. The incidence of clot migration leading to a change from retrievable to nonretrievable location was identified and compared between the two treatment groups (IVT versus placebo).Results: Two hundred twenty patients were assessed. Clot migration from a retrievable to nonretrievable location occurred in 37 patients: 21 patients (19.3%) in the placebo group and 16 patients (14.4%) in the IVT group. No significant difference was identified in the incidence of clot migration leading to inaccessibility between groups (P=0.336).Conclusions: Our results did not show increased clot migration leading to clot inaccessibility in patients treated with IVT.Keywords: endovascular procedures; follow-up; incidence; radiology, interventional; thrombolytic therapy.
刘建仁 2021-03-13阅读量9349
病请描述：大血管缺血性卒中后血管内血栓切除术：美国的应用、结果和再入院摘要背景：在发表了证明血栓切除术有效性的试验后，2015年修订了社会指南，建议对大血管卒中采用这种方法。目的评估美国急性脑卒中大规模血栓切除术后2年内血栓切除率、不良事件、转归和再入院率。材料与方法在这项回顾性研究中，作者查询了2016年至2017年间接受血栓切除术患者的全国住院样本和全国再入院数据库。血栓切除率比较采用χ2检验。采用多变量Poisson回归和医院层面的聚类分析，获得影响常规出院、死亡率和再入院的因素的校正风险比（aRRs）。结果共收治颈内动脉或大脑中动脉卒中患者290460例（平均年龄70.5±14.2岁，女性148620例），其中30835例（10.6%）行血栓切除术。90岁或以上患者的血栓切除率较低（24090例患者中1815例，占7.5%），黑人患者（43365例患者中4280例，占9.9%），收入最低的患者（85905例患者中8520例，占9.9%）和在西南部中心区医院治疗的患者（34355例患者中2695例，占7.8%）（P<0.001）。住院病死率为12.1%（30835例中3740例），出院率为19.1%（30835例中5900例）。在校正分析中，90岁或以上的患者（aRR:0.12；95%CI:0.09,0.16；P<0.001）和80岁以上的患者（aRR:0.37；95%CI:0.33,0.41；P<0.001）常规出院的可能性较小。90岁或以上的患者（aRR:1.78；95%CI:1.48，2.14；P<0.001）、80岁以上的老人（aRR:1.76；95%CI:1.51，2.06；P<0.001）、亚洲人和/或太平洋岛民（aRR:1.21；95%CI:1.06，1.39；P=0.005）以及在教学中接受治疗的患者（aRR:1.20；95%CI:1.07，1.34；P=0.001）或在中南部接受治疗的患者（aRR:1.35；95%CI:1.14，1.60）；P<0.001）医院有较高的死亡风险。出院后，18.9%的患者（18274例中的3449例）在90天内再次入院。结论血栓切除率和结果受人口统计学、社会经济和医院相关因素的影响。不到五分之一的患者出院回家，近五分之一的患者在90天内再次入院，死亡率和预后可能不如已发表的试验。©RSNA，2021在线补充材料可用于本文。Radiology. 2021 Feb 16;203082. doi: 10.1148/radiol.2021203082. Online ahead of print.Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United StatesPedram Golnari 1, Pouya Nazari 1, Sameer A Ansari 1, Michael C Hurley 1, Ali Shaibani 1, Matthew B Potts 1, Babak S Jahromi 1Affiliations expandPMID: 33591890 DOI: 10.1148/radiol.2021203082AbstractBackground Following publication of trials demonstrating the efficacy of thrombectomy, societal guidelines were revised in 2015 to recommend this procedure for large-vessel stroke. Purpose To evaluate real-world thrombectomy rates, adverse events, outcomes, and readmissions across the United States in the 2 years after large-scale adoption of thrombectomy for acute stroke. Materials and Methods In this retrospective study, the authors queried the National Inpatient Sample and Nationwide Readmissions Database for patients undergoing thrombectomy between 2016 and 2017. Thrombectomy rates were compared by using the χ2 test. Adjusted risk ratios (aRRs) were obtained for factors affecting routine discharge, mortality, and readmission by using multivariable Poisson regression with clustering at the hospital level. Results There were 290 460 admissions (mean age, 70.5 years ± 14.2 [standard deviation]; 148 620 women) for internal carotid or middle cerebral artery stroke; 30 835 (10.6%) of these patients underwent thrombectomy. Thrombectomy rates were lower in patients aged 90 years or older (1815 of 24 090 patients, 7.5%), Black patients (4280 of 43 365 patients, 9.9%), patients with the lowest income (8520 of 85 905 patients, 9.9%), and those treated in West South Central division hospitals (2695 of 34 355 patients, 7.8%) (P < .001 for all). The inpatient mortality rate was 12.1% (3740 of 30 835 patients), and 19.1% of patients (5900 of 30 835) were discharged to home. In adjusted analyses, routine discharge was less likely in patients aged 90 years or older (aRR: 0.12; 95% CI: 0.09, 0.16; P < .001) and octogenarians (aRR: 0.37; 95% CI: 0.33, 0.41; P < .001). Patients aged 90 years or older (aRR: 1.78; 95% CI: 1.48, 2.14; P < .001), octogenarians (aRR: 1.76; 95% CI: 1.51, 2.06; P < .001), Asians and/or Pacific Islanders (aRR: 1.21; 95% CI: 1.06, 1.39; P = .005), and those treated in teaching (aRR: 1.20; 95% CI: 1.07, 1.34; P = .001) or West South Central division (aRR: 1.35; 95% CI: 1.14, 1.60; P < .001) hospitals had a higher risk of death. Following discharge, 18.9% of patients (3449 of 18 274) were readmitted within 90 days. Conclusion Rates and outcomes of thrombectomy are affected by demographic, socioeconomic, and hospital-related factors. Fewer than one-fifth of patients are discharged to home, nearly one-fifth are readmitted within 90 days, and mortality and outcomes may be less favorable than in published trials. © RSNA, 2021 Online supplemental material is available for this article.Similar articles
刘建仁 2021-03-13阅读量8740
病请描述：在美国绘制血管内卒中护理的路径图及其对运输模型的影响摘要背景：这项横断面研究的目的是确定60分钟地面或空中可到达经认可或国家指定的血管内卒中中心（ECC）和非血管内卒中中心（NECC）的美国人口百分比，以及30分钟车程内有ECC的NECC百分比。方法：将脑卒中中心大致分为ECCs和NECCs。对中风中心进行地理测绘。将人口划分为普查区，并计算其质心。估计了从质心到最近的ECC和NECC的最快空中和地面旅行时间。结果：总体而言，49.6%的美国居民有60分钟的地面访问ECCs。大约37.7%（1.13亿人）缺少60分钟的地面或空中ECCs通道。大约84.4%的人有60分钟的时间进入NECC。77.9%的人有地面通道。大约738名NECC（45.4%）在30分钟车程内发生ECC。结论：近三分之一的美国人口缺乏60分钟的血管内卒中护理，但这是一个很大的变量。交通模式和额外中心的规划应根据现有设施的位置和邻近程度，针对每个州进行调整。J Neurointerv Surg. 2021 Feb 16;neurintsurg-2020-016942. doi: 10.1136/neurintsurg-2020-016942. Online ahead of print.Mapping access to endovascular stroke care in the USA and implications for transport modelsJared Aldstadt # 1, Muhammad Waqas # 2 3, Misa Yasumiishi 1, Maxim Mokin 4 5, Vincent M Tutino 2 6, Hamid H Rai 7, Felix Chin 7, Bennett R Levy 8, Ansaar T Rai 9, J Mocco 10, Kenneth V Snyder 3 11, Jason M Davies 3 12, Elad I Levy 2 3, Adnan H Siddiqui 13 3Affiliations expandPMID: 33593798 DOI: 10.1136/neurintsurg-2020-016942AbstractBackground: The purpose of this cross-sectional study was to determine the percentage of the US population with 60 min ground or air access to accredited or state-designated endovascular-capable stroke centers (ECCs) and non-endovascular capable stroke centers (NECCs) and the percentage of NECCs with an ECC within a 30 min drive.Methods: Stroke centers were identified and classified broadly as ECCs or NECCs. Geographic mapping of stroke centers was performed. The population was divided into census blocks, and their centroids were calculated. Fastest air and ground travel times from centroid to nearest ECC and NECC were estimated.Results: Overall, 49.6% of US residents had 60 min ground access to ECCs. Approximately 37.7% (113 million) lack 60 min ground or air access to ECCs. Approximately 84.4% have 60 min access to NECCs. Ground-only access was available to 77.9%. Approximately 738 NECCs (45.4%) had an ECC within a 30 min drive.Conclusion: Nearly one-third of the US population lacks 60 min access to endovascular stroke care, but this is highly variable. Transport models and planning of additional centers should be tailored to each state depending on location and proximity of existing facilities.
刘建仁 2021-03-13阅读量8920
病请描述：背景与目的：后循环大血管闭塞时血管再通的成功被认为是至关重要的，尽管与前循环相比，临床有用性的证据尚不确定。本研究的目的是评估良好临床结果的预测因素，并分析首过血栓切除术的效果。材料和方法：对2016年1月至2019年7月期间欧洲10个大容量卒中中心进行回顾性、多中心、观察性研究。只有急性基底动脉闭塞或单一显性椎动脉闭塞（“功能性”基底动脉闭塞）的患者进行了3个月的mRS检查。评估临床、程序和放射学数据，并评估这些参数与功能结果和首过效应之间的关系。结果：共纳入191例患者。较低的基线NIHSS评分（校正OR，0.77；95%CI，0.61-0.96；P=0.025）和较高的基线MR成像后循环方面（校正OR，3.01；95%CI，1.03-8.76；P=0.043）是预后较好的预测因素。使用大口径导管（校正OR，2.25；95%CI，1.08-4.67；P=0.030）是首次成功再灌注的积极预测因子，而使用联合技术是消极预测因子（校正OR，0.26；95%CI，0.09-0.76；P=0.014）。结论：我们的回顾性分析表明，较低的NIHSS基线评分和较高的MR后循环成像是良好临床结果的预测因素。大口径导管的使用是首次通过改良tici2b/3的积极预测因子；联合技术的使用是消极预测因子。©2021美国神经放射杂志。
刘建仁 2021-03-07阅读量8792
病请描述：线粒体靶向双光子比率探针观察脑卒中时炎症诱导的有丝分裂吞噬作用 摘要 这项研究报道了一种新的，pH敏感的，以线粒体为靶点的双光子比率探针（Mito-BNO）的开发，用于实时跟踪线粒体吞噬功能，这一过程在中风期间可以在脑组织中加速。Mito-BNO具有良好的线粒体定位能力（皮尔逊相关系数，r=0.91），并能有效地将线粒体与溶酶体和内质网等其他亚细胞器区分开来（r=0.40和r=0.33）。同时，pKa值（5.23±0.03）和pH可逆性提示，有丝分裂BNO可通过共聚焦成像实时追踪有丝分裂吞噬。最重要的是，在氧-糖剥夺/再灌注（OGD/R）过程中，有丝分裂吞噬与脑卒中期间神经炎症之间的关系已经通过评估有丝分裂BNO染色的PC12细胞在有无抗炎治疗的情况下的荧光得到了成功证实。结果表明，脑卒中时有丝分裂吞噬的发生是由神经炎症引起的氧化应激所致。本研究将有助于进一步了解脑卒中的发病机制，为脑卒中的早期诊断和治疗提供潜在的新靶点，也有助于开发脑卒中的治疗药物。
刘建仁 2021-03-05阅读量8978
病请描述： 拓宽腺苷脱氨酶2缺乏症的神经影像学特征 摘要 腺苷脱氨酶2缺乏症（OMIM#615688）是一种常染色体隐性遗传疾病，具有广泛的临床特征，包括中小型血管病变，但有关相关神经影像学特征的资料在文献中仍然很少。在这里，我们描述了12例经基因证实的腺苷脱氨酶2缺乏症患者的临床神经影像学特征（6名男性；发病年龄中位数为1.3岁；基因诊断年龄中位数为15.5岁）。我们的发现扩展了这种情况的神经影像学表型，除了多发性、复发性脑腔隙性缺血性和/或出血性中风、脊柱梗死和颅内动脉瘤外，还显示了脑微出血和基底池和周围池中特殊的、可能的炎性血管周围组织。这些发现与早期临床发病、阳性家族史、炎症发作和全身异常一起，应引起腺苷脱氨酶2缺乏症的怀疑，从而促使进行基因评估和建立肿瘤坏死因子抑制剂，对神经系统的预后有潜在的重大影响。 ©2021美国神经放射杂志。
刘建仁 2021-03-04阅读量9512