文摘
摘要目的:比较长期的结果和转换的可能性来安慰照顾大血管闭塞(LVO)中风严重基线残疾患者接受血管内血栓切除术(EVT)与医疗管理。
背景:基线残疾患者占到三分之一的中风的演讲,但传统上被排除在急性中风的早期临床试验的干预措施。尽管越来越多的证据支持一个受益于血管内血栓切除术,仍存在重大争议的治疗选择。
设计/方法:个人面对LVO从前瞻性维护数据库被确定从2017年1月至2020年12月。严重的基线残疾被定义为改良Rankin规模(夫人)3 - 5。三角洲夫人被定义为基线之间的区别和90天的物流太太和序数回归进行评估EVT和临床结果之间的关系。
结果:的175/1007(17%)患者与基线严重残疾。年龄中位数为82(差70 - 89年),和59%是女性。32例(18%)患者严重的基线处理EVT残疾。EVT是独立与改进的δ夫人(B =−1.048;95% ci =−1.777−0.318;p = 0.005)当会计年龄和署。然而,EVT没有减少过渡舒适护理的可能性(优势比= 0.794;95% ci = 0.347, 1.818;p = 0.585)当会计年龄和署。七十六例(43%)患者基线严重残疾被转换到舒适护理。 Of the 99 patients who were not transitioned to comfort care, 18 were treated with EVT. In this subgroup not transitioned to comfort care, EVT was independently associated with improved delta mRS (B=−2.794; 95%CI=−4.002,−1.586; p<0.0001) when accounting for age and NIHSS.
结论:患者基线严重残疾,EVT与少中风后积累的残疾没有限制过渡舒适护理。EVT兼容goal-concordant护理患者的基线严重残疾;它不应该经常保留的唯一基础基线残疾。
披露:Awad博士没有披露。杨医生没有披露。安德列夫博士没有披露。Dmytriw博士没有披露。Vranic博士没有披露。詹姆斯d·Rabinov在辉瑞股票。Stapleton博士已经收到个人薪酬在500 - 4999美元的范围为在科学咨询服务或数据安全监测委员会海关循环。达斯博士没有披露。立即家人Singhal博士已收到生原体的个人作为一个雇员补偿。Singhal博士已经收到个人薪酬在5000 - 9999美元的范围作为一个法医学的公司的专家证人。 Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (Education) with Biogen. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. The institution of Aman Patel has received research support from Siemens. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
