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基底动脉闭塞性卒中的血管内治疗
Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion


Lucianne C.M. Langezaal ... 心脑血管疾病 • 2021.05.20
NEJM 动画解读

基底动脉闭塞的血管内治疗
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• 基底动脉闭塞的血管内治疗仍未证实 • 血管内取栓术联合和不联合阿替普酶静脉溶栓治疗急性缺血性卒中的比较研究 • 取栓术前溶栓治疗——溶栓还是相信DIRECT-MT

摘要


背景

血管内治疗对基底动脉闭塞性卒中患者的疗效尚未经过充分研究。


方法

我们以1∶1的比例将基底动脉闭塞性卒中估计发生时间后6小时内的患者随机分组,两组分别接受血管内治疗或标准药物治疗。主要结局是良好功能结局,定义为90日时的改良Rankin量表评分(范围,0~6分,0分表示无残疾,3分表示中度残疾,6分表示死亡)为0~3分。主要安全性结局是治疗开始后3日内的有症状颅内出血和90日时的死亡率。

 

结果

共计300例患者(血管内治疗组154例,药物治疗组146例)被纳入试验。血管内治疗组78.6%的患者和药物治疗组79.5%的患者使用了静脉内溶栓治疗。血管内治疗的中位开始时间为卒中发生后4.4小时。血管内治疗组154例患者中的68例(44.2%)和药物治疗组146例患者中的55例(37.7%)达到了良好功能结局(风险比,1.18;95%置信区间[CI],0.92~1.50)。血管内治疗后4.5%的患者和药物治疗后0.7%的患者发生了有症状颅内出血(风险比,6.9;95% CI,0.9~53.0);两组中90日时的死亡率分别为38.3%和43.2%(风险比,0.87;95% CI,0.68~1.12)。


结论

在基底动脉闭塞性卒中患者中,血管内治疗和药物治疗在良好功能结局方面无显著差异,但如主要结局宽泛的置信区间所示,试验结果可能无法排除血管内治疗的显著益处。我们需要开展更大规模试验来确定血管内治疗对基底动脉闭塞的疗效和安全性(由荷兰心脏基金会[Dutch Heart Foundation]等资助,BASICS在ClinicalTrials.gov注册号为NCT01717755,在荷兰试验注册系统[Netherlands Trial Register]注册号为NL2500)。





作者信息

Lucianne C.M. Langezaal, M.D., Erik J.R.J. van der Hoeven, M.D., Ph.D., Francisco J.A. Mont’Alverne, M.D., Ph.D., João J.F. de Carvalho, M.D., Fabrício O. Lima, M.D., Ph.D., Diederik W.J. Dippel, M.D., Ph.D., Aad van der Lugt, M.D., Ph.D., Rob T.H. Lo, M.D., Ph.D., Jelis Boiten, M.D., Ph.D., Geert J. Lycklama à Nijeholt, M.D., Ph.D., Julie Staals, M.D., Ph.D., Wim H. van Zwam, M.D., Ph.D., Paul J. Nederkoorn, M.D., Ph.D., Charles B.L.M. Majoie, M.D., Ph.D., Johannes C. Gerber, M.D., Mikael Mazighi, M.D., Ph.D., Michel Piotin, M.D., Ph.D., Andrea Zini, M.D., Stefano Vallone, M.D., Jeannette Hofmeijer, M.D., Ph.D., Sheila O. Martins, M.D., Ph.D., Christian H. Nolte, M.D., Ph.D., Kristina Szabo, M.D., Ph.D., Francisco A. Dias, M.D., Ph.D., Daniel G. Abud, M.D., Ph.D., Marieke J.H. Wermer, M.D., Ph.D., Michel J.M. Remmers, M.D., Hauke Schneider, M.D., Ph.D., Christina M. Rueckert, M.D., Karlijn F. de Laat, M.D., Ph.D., Albert J. Yoo, M.D., Ph.D., Pieter-Jan van Doormaal, M.D., Adriaan C.G.M. van Es, M.D., Ph.D., Bart J. Emmer, M.D., Ph.D., Patrik Michel, M.D., Ph.D., Volker Puetz, M.D., Heinrich J. Audebert, M.D., Ph.D., Octavio M. Pontes-Neto, M.D., Ph.D., Jan-Albert Vos, M.D., Ph.D., L. Jaap Kappelle, M.D., Ph.D., Ale Algra, M.D., Ph.D., and Wouter J. Schonewille, M.D., Ph.D. for the BASICS Study Group*
From the Departments of Radiology (L.C.M.L., E.J.R.J.H., J.-A.V.) and Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Departments of Neurology (D.W.J.D.) and Radiology and Nuclear Medicine (A.L., P.-J.D.), Erasmus University Medical Center, Rotterdam, the Departments of Radiology (R.T.H.L.) and Neurology (L.J.K.) and the Department of Neurology and Neurosurgery, Brain Center, and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, and Utrecht University (A.A.), Utrecht, the Departments of Neurology (J.B.) and Radiology (G.J.L.N.), Haaglanden Medical Center, and the Department of Neurology, Haga Hospital (K.F.L.), The Hague, the Departments of Neurology (J.S.) and Radiology and Nuclear Medicine (W.H.Z.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Departments of Neurology (P.J.N.) and Radiology (C.B.L.M.M., B.J.E.), Amsterdam University Medical Center, Amsterdam, the Department of Neurology, Rijnstate Hospital, Arnhem, and the Department of Clinical Neurophysiology, University of Twente, Enschede (J.H.), the Departments of Neurology (M.J.H.W.) and Radiology (A.C.G.M.E.), Leiden University Medical Center, Leiden, and the Department of Neurology, Amphia Hospital, Breda (M.J.M.R.) — all in the Netherlands; the Interventional Neuroradiology Service (F.J.A.M.) and the Neurology Service (J.J.F.C., F.O.L.), Hospital Geral de Fortaleza, Fortaleza, the Department of Neurology, Federal University of Rio Grande do Sul and Hospital de Clinicas de Porto Alegre, Porto Alegre (S.O.M.), and the Stroke Service, Neurology Division, Department of Neuroscience and Behavioral Sciences (F.A.D., O.M.P.-N.), and the Interventional Neuroradiology Service, Department of Medical Imaging, Hematology and Oncology (D.G.A.), Ribeirão Preto Medical School, University of São Paulo, São Paulo — all in Brazil; the Institute of Neuroradiology (J.C.G.) and the Department of Neurology (V.P.), Dresden Neurovascular Center, University Hospital Carl Gustav Carus, and Medizinische Fakultät Carl Gustav Carus (H.S.), Technische Universität Dresden, Dresden, the Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin (C.H.N., H.J.A.), the Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim (K.S.), the Department of Neurology, University Hospital Augsburg, Augsburg (H.S.), and the Department of Neurology, Oberschwabenklinik, Ravensburg (C.M.R.) — all in Germany; Rothschild Foundation Hospital, INSERM Unité 1148, University of Paris, Paris (M.M., M.P.); the IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna (A.Z.), and the Neuroradiology Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena (S.V.) — both in Italy; the Texas Stroke Institute, Fort Worth (A.J.Y.); and the Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland (P.M.). Address reprint requests to Dr. Schonewille at the St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands, or at w.schonewille@antoniusziekenhuis.nl. *A complete list of the members of the BASICS Study Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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