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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Endovascular Therapy in Mild Ischemic Strokes Presenting Under 6 hours: An International Survey
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Endovascular Therapy in Mild Ischemic Strokes Presenting Under 6 hours: An International Survey

机译：在6个小时内提出的轻度缺血卒中血管疗法：国际调查

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Background: Endovascular therapy (EVT) for patients with mild ischemic stroke (NIHSS <= 5) and visible intracranial occlusion remains controversial, including within 6 hours of symptom onset. We conducted a survey to evaluate global practice patterns of EVT in this population. Methods: Vascular stroke clinicians and neurointerventionalists were invited to participate through professional stroke listservs. The survey consisted of six clinical vignettes of mild stroke patients with intracranial occlusion. Cases varied by NIHSS, neurological symptoms and occlusion site. All had the same risk factors, time from symptom onset (5h) and unremarkable head CT. Advanced imaging data was available upon request. We explored independent case and responder specific factors associated with advanced imaging request and EVT decision. Results: A total of 482/492 responders had analyzable data ([median age 44 (IQR 11.25)], 22.7% women, 77% attending, 22% interventionalist). Participants were from USA (45%), Europe (32%), Australia (12%), Canada (6%), and Latin America (5%). EVT was offered in 48% (84% M1, 29% M2 and 19% A2) and decision was made without advanced imaging in 66% of cases. In multivariable analysis, proximal occlusion (M1 vs. M2 or A2, p<0.001), higher NIHSS (p<0.001) and fellow level training (vs. attending; p=0.001) were positive predictors of EVT. Distal occlusions (M2 and A2) and higher age of responders were independently associated with increased advanced imaging requests. Compared to US and Australian responders, Canadians were less likely to offer EVT, while those in Europe and Latin America were more likely (p<0.05). Conclusions: Treatment patterns of EVT in mild stroke vary globally. Our data suggest wide equipoise exists in current treatment of this important subset of mild stroke.
机译：背景：轻度缺血性中风（NIHSS<=5）和可见颅内阻塞患者的血管内治疗（EVT）仍存在争议，包括症状出现后6小时内。我们进行了一项调查，以评估该人群中EVT的全球实践模式。方法：通过专业卒中列表服务邀请血管卒中临床医生和神经干预医生参与。该调查包括6例轻度脑卒中合并颅内阻塞患者的临床案例。病例因NIHSS、神经症状和闭塞部位而异。所有人都有相同的危险因素，症状出现的时间（5h）和不显著的头部CT。可根据要求提供高级成像数据。我们探讨了与高级成像请求和EVT决策相关的独立病例和应答者特定因素。结果：共有482/492名应答者有可分析的数据（[中位年龄44岁（IQR 11.25）]，22.7%的女性，77%的参与者，22%的干预者）。参与者来自美国（45%）、欧洲（32%）、澳大利亚（12%）、加拿大（6%）和拉丁美洲（5%）。在48%（84%的M1、29%的M2和19%的A2）的病例中提供了EVT，66%的病例在未进行高级成像的情况下做出了决定。在多变量分析中，近端闭塞（M1 vs.M2或A2，p<0.001）、较高的NIHSS（p<0.001）和同伴水平的训练（vs.参加；p=0.001）是EVT的积极预测因子。远端闭塞（M2和A2）和较高年龄的应答者与增加的高级成像请求独立相关。与美国和澳大利亚的应答者相比，加拿大人提供EVT的可能性较小，而欧洲和拉丁美洲的应答者提供EVT的可能性更大（p<0.05）。结论：轻度卒中的EVT治疗模式在全球范围内各不相同。我们的数据表明，目前对这一重要的轻度中风亚型的治疗存在广泛的均势。

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