|
全球卒中领域的最重要学术盛宴之一国际卒中大会2022（International Stroke Conference 2022, ISC2022）将于2月9-11日在美国洛杉矶新奥尔良举行，会议由美国心脏协会(AHA)/美国卒中协会(ASA)主办。 国际卒中大会(ISC)是世界上最大的致力于脑血管疾病科学与治疗的学术会议之一，为期三天17个类别的演讲预计吸引来自全球数千余名卒中和脑血管专家及相关人士参会。 国内新型冠状病毒（COVID-19）疫情较去两年稳定，但国外仍疫情肆虐。 浪潮联盟取栓论坛成员连续三年精译部分论文摘要，与全国同道共享精神粮食。时逢新年，祝您新春快乐！
01 超24h取栓 超24小时机械取栓：一项国际多中心队列研究 结论：尽管超24小时前循环大血管闭塞血管内治疗患者发生症状性脑出血的风险数量增加，但可能与更好的功能预后相关。进一步的前瞻性研究是必要的。 洲说取栓：超24小时取栓，是未来的一个热点，浪潮联盟取栓论坛2020年组举办了专题线上会议进行研讨：精华回顾 | 取栓论坛 云端论剑 超24小时取栓专场 会议回顾 Abstract 36: Endovascular ThrombectomyBeyond 24 Hours From Last Known Well: A Pooled Multicenter International Cohort Amrou Sarraj, et, al. Conclusions: EVT may be associated withbetter functional outcomes, despite numerically increased risk of sICH inpatients presenting with anterior circulation LVO beyond 24 hours. Furtherprospective studies are warranted. 02 氯吡格雷口服与持续治疗 颈动脉支架置入术前，氯吡格雷片劣于持续氯吡格雷治疗 结论：在接受颈动脉支架治疗的患者中，与术前持续氯吡格雷治疗前相比，氯吡格雷片剂与更高的不良反应发生率相关。因此，氯吡格雷片可能并不等同于持续氯吡格雷预治疗。 洲说取栓：十年磨一剑，CREST研究十年随访结果(CarotidRevascularization Endarterectomy versus Stenting Trial, CREST) 。CREST纳入美国108个中心及加拿大9个中心的2522名患者。相关介绍：https:///ct2/show/NCT00004732 Abstract 37: Clopidogrel Bolus Is InferiorTo Sustained Clopidogrel Pre-treatment In Patients Undergoing Carotid ArteryStent Placement Adnan I Qureshi, et, al. Conclusion: Clopidogrel bolus wasassociated with higher rates of adverse outcomes compared with sustained clopidogrelpre-treatment in patients who underwent CAS. Therefore, clopidogrel bolus maynot be equivalent to sustained clopidogrel pre-treatment. 03 收缩压与预后 血管内治疗后血压变化的幅度和结果 结论：成功再灌注后收缩压变化与不良预后呈线性关系，与基线收缩压相比降低越少，不良预后的风险越高。 Abstract 38: Magnitude Of Blood Pressure Change After Endovascular Therapy And Outcomes: Insight From Bp Target Trial Mohammad Anadani, et, al. Conclusion: After successful reperfusion, systolicblood pressure change had a linear relationship with poor outcome and the riskof poor outcome was higher with less reduction from the baseline SBP.
04 放射组学一把再通 Escape-na1试验中放射组学与人类预测血管内治疗一把通的能力 结论：基于放射组学的CT平扫和CTA血栓特征机器学习模型在预测血管内治疗急性脑卒中患者一把通方面优于专家和非放射组学图像特征。 洲说取栓：人工智能机器学习，不给专家留活口，搬砖路上雪上加霜。 Abstract 39: Ability Of Radiomics VersusHumans In Predicting First-pass Effect After Endovascular Treatment In The Escape-na1Trial Fouzi Bala, et, al. Conclusion: A radiomics-based machinelearning model of thrombus characteristics on non-contrast CT and CTangiography performs better than experts and non-radiomics imagecharacteristics in predicting FPE in patients with acute stroke treated withEVT. 05 后循环直接桥接 静脉注射或不注射阿替普酶的血管内治疗基底动脉闭塞所致急性缺血性卒中 刘丽萍教授团队 结论：本研究表明，与直接血管内治疗（EVT）相比，在发病24小时内接受治疗的基底动脉闭塞患者中，先进行标准静脉溶栓治疗(IVT)的EVT与更好的功能结果相关。荟萃分析显示，在BAO患者中，先进行IVT，再进行EVT的疗效相似。 洲说取栓：2021年卒中领域十大进展之一：前循环取栓，直接还是桥接悬而未定。这篇后循环研究结论似乎与前循环类似。 Abstract 40: Endovascular Treatment With OrWithout Intravenous Alteplase For Acute Ischemic Stroke Due To Basilar ArteryOcclusion Ximing Nie and Liping Liu Conclusions: This study showed thatcompared to direct EVT, EVT with standard IVT first was associated with betterfunctional outcomes in BAO patients treated within 24 hours of onset. Themeta-analysis demonstrated the similar favorable efficacy of IVT first followedby EVT in BAO patients. 06 85岁后取栓 血管内治疗后85岁及以上急性缺血性脑卒中患者的功能预后--Hermes荟萃分析的子研究 结论：与保守治疗相比，发病前具有独立生活功能的85岁患者在接受血管内治疗时更容易获得良好的功能结果，死亡率较低，症状性脑出血发生率无差异。因此，该亚组患者不应被排除在取栓行列之内。 洲说取栓：初识HERMES协作组，是2016年柳叶刀上五大前循环取栓RCT荟萃分析，手握几大金矿开挂组织的又一贡献。春节期间，饮食适度，锻炼身体，优雅地活到85。 Abstract 41: Functional Outcome Of Patients85 Years Or Older With Acute Ischemic Stroke Following Endovascular Treatment -A Substudy Of The Hermes Meta-analysis Rosalie V McDonough, , , HERMEScollaborators Conclusion: Patients ≥85 years old withindependent premorbid function more often achieve good functional outcomes whentreated with EVT compared to conservative management, with lower rates ofmortality and no differences in sICH rates. EVT should therefore not bewithheld in this subgroup.
07 侧枝麻醉与预后 侧支循环改变了麻醉对取栓预后的影响：来自EXTEND-IA、EXTEND-IA TNK I 及II, 以及SELECT患者的合并分析 结论：全身麻醉（GA）与血管内治疗后更差的功能结果相关，尤其是侧支循环不良的患者。这些发现对GA与非GA的随机试验具有指导意义。 洲说取栓：全麻还是局麻，已有不少高质量文献报道，孰优孰劣尚未盖棺定论。在国内一些中心全麻能否及时到位，取决于介入手术团队与麻醉科关系深浅。这个研究提示：侧支不好时，放过麻醉科吧。 Abstract 42: The Effect Of Anesthesia OnThrombectomy Outcomes Is Modified By Collateral Flow: Pooled Patient LevelAnalysis From EXTEND-IA, EXTEND-IA TNK Part I And II, And SELECT Amrou Sarra, et, al. Conclusion: general anesthesia (GA) was associated with worse functionaloutcomes after EVT, particularly in patients with poor collaterals. Thesefindings have implications for randomized trials of GA vs non-GA. 08 地区剥夺指数（Area Deprivation Index, ADI） 地区剥夺指数、卒中结局和结构改变改善血栓切除术 结论：在整个纽约市普查区域，较高的地区剥夺指数（ADI）与取栓的延迟相关。ADI较高地区的取栓中心可以在减少卒中患者医疗差异方面发挥作用。 洲说取栓：区域剥夺指数（ADI）是基于三十年前由卫生资源和服务管理局（HSA）创建的一项措施，此后由威斯康星大学Amy Kind博士、MD博士和研究团队在麦迪逊分校进行了改进、调整和验证。它允许根据感兴趣地区的社会经济劣势（例如州或国家层面）对社区进行排名。它包括收入、教育、就业和住房质量等理论领域的因素。它可以用于告知医疗服务和政策，尤其是对最弱势的社区群体。https://www.neighborhoodatlas.medicine./ Abstract 74: Area Deprivation Index, StrokeOutcomes, And Structural Changes To Improve Access To Thrombectomy Naoum Fares Marayati, et, al. Conclusions: Across urban census tracts, ahigher ADI was associated with delays in access to thrombectomy. Thrombectomycenters in areas with higher ADI can play a role in reducing healthcaredisparities for stroke patients. 09 速度与预后 急性缺血性卒中患者从入院到血管内取栓术的速度与健康相关生活质量之间的关系 结论：在大血管闭塞患者中，更快的血管内治疗（EVT）门穿刺时间（DPT）与更高的健康相关生活质量密切相关。这些结果支持EVT速度对患者报告结果的有益影响，并鼓励通过优化工作流程来提高患者生活质量。 洲说取栓：缩短DPT已成为共识及所有开展这一业务卒中中心努力的目标， ESCAPE-NA1研究用其超过1000例的样本量进一步证实这一点。 Abstract 75: Association Between Speed FromHospital Arrival To Endovascular Thrombectomy And Health-Related Quality OfLife In Patients With Acute Ischemic Stroke Raed A Joundi, , , ESCAPE-NA1 Investigators Conclusion: Faster door-to-puncture EVTtime is strongly associated with greater health-related quality of life acrossall domains in patients with large vessel occlusion. These results support thebeneficial impact of speed of EVT on patient-reported outcomes and encourageefforts to improve quality of life in patients by optimizing workflows.
10 接地气的延长时间窗 拓展时间窗血管内治疗的卒中影像学选择：系统回顾与荟萃分析。 结论：尽管使用或不使用额外的高级成像技术，在延长窗上进行EVT的卒中患者中，仍有很大比例的患者可以实现功能独立性。两组患者的死亡率和症状性出血相似。 洲说取栓：晚时间窗，设备不那么完备的单位可能也可以玩。小米+步枪也要想着怎么把飞机大炮干翻。 Abstract 76: Stroke Imaging Selection For Endovascular Therapy In The Extended Window: Systematic Review AndMeta-analysis. Joel M Sequeiros Chirinos Conclusion: This meta-analysis suggeststhat functional independence in patients with stroke who underwent EVT on theextended window can be achieved in a high proportion of patients despite theuse or not of additional advanced imaging. Both groups also presented similarmortality and sICH.
11 侧枝与再通 急性缺血性卒中血管内治疗后侧枝循环状态和再通 结论：侧枝循环状态与血管内治疗后成功再通的可能性无关，也不会改变再通成功与功能结果之间的关系。 洲说取栓：天行有常,不为尧存,不为桀亡。荷兰MR CLEAN Registry的多中心前瞻性队列研究的又一成果。 Abstract 77: Collateral Status AndRecanalization After Endovascular Treatment For Acute Ischemic Stroke Simone Uniken Venema, et, al. Conclusions: Collateral status is notassociated with the probability of successful recanalization after endovasculartreatment and does not modify the association between successful recanalizationand functional outcome. 12 桡动脉入路颈动脉支架 经桡动脉和经股动脉途径进行颈动脉血管成形术及支架置入术的单中心比较 结论：尽管经桡动脉入路的技术失败率相对较高，但经桡动脉入路的颈动脉支架患者的主要出血并发症发生率低于经股动脉入路患者。 Abstract 78: A Single Center Comparison Of Transradial And Transfemoral Approaches For Carotid Angioplasty And StentPlacement Nitish Kumar, et, al. Conclusions: The rates of major hemorrhagiccomplications were lower among patients who underwent CAS via transradialapproach compared with CAS using transfemoral approach although the rates oftechnical failure remain relatively high with transradial approach.
13 绕道初级卒中中心与否 绕道初级卒中中心至取栓能力中心与初级中心二次转院比较 结论：这项研究的结果表明，在距离小于20英里的地方，直接旁路到中心血管内血栓切除术中心与更好的治疗时间和结果相关。 洲说取栓：1英里=1.6公里。我国地大物博，很多取栓中心覆盖范围超过100公里。 Abstract 79: Direct Bypass To EndovascularCapable Stroke Center Compared To Secondary Transfer From Primary StrokeCenters Jae Beom Hong, et, al. Conclusion: The results of this studysuggest where the distance is less than 20 miles, direct bypass to centralendovascular thrombectomy capable stroke center is associated with betterprocess times and outcomes.
14 绕行急诊与否 接受机械取栓的大血管闭塞患者，绕行急诊与否的成本倾向调整分析 结论：对于因大血管闭塞（LVOs）而接受急性机械取栓的患者，与第一次转移到急诊室的患者相比，直接转移到导管室与总住院成本降低6000美元以上有关。本研究进一步支持LVO接受机械取栓患者的DTAS转移。 洲说取栓：绕行急诊与否，在国内可能需要因地制宜。 Abstract 80: Hospital Cost Of Direct ToAngiography Suite Compared To Emergency Department Transfers For Large VesselOcclusions Undergoing Mechanical Thrombectomy: A Propensity Adjusted Analysis Joshua Catapano, et, al. Conclusion: Direct-to-angiography-suitetransfer (DTAS) for patients undergoing an acute mechanical thrombectomy for a largevessel occlusions (LVOs) was associated with a greater than $6,000 decreasetotal hospital cost compared to patients first transferred to the emergencydepartment (ED). The present study further supports DTAS transfer for patientsundergoing mechanical thrombectomy for LVO. 15 有多少人需要取栓？ 2021美国人群符合血管内治疗治疗条件患者的预测 结论：2021美国的18484名成人患者符合严格的血管内治疗（EVT）合格标准。估计每年有15699名NIHSS评分较低的患者、9621名影像学表现不佳的患者和28107名中风前已有残疾的患者有资格接受EVT。无论是现在还是将来，美国的卒中系统应该优化，以处理所有符合EVT条件的卒中患者。 Abstract 132: Projections Of EndovascularTherapy-eligible Patients For The Us Population In 2021 Eva Mistry, et, al. Conclusions: It is estimated 18,484 adultpatients in the US in 2021 meet strict Endovascular Therapy (EVT) eligibilitycriteria. An estimated 15,699 patients with low NIHSS, 9621 with unfavorable imaging,and 28,107 with pre-stroke disability may become eligible for EVT in the futureannually. US stroke systems should be optimized to handle all EVT-eligiblestroke patients both now and in the future. 16 药物洗脱Resolute支架 与Wingspan相比，Resolute支架更少出现围手术期并发症，长期再狭窄率显著改善 结论：我们的经验是，R-onyx药物洗脱球囊支架在治疗症状性颅内动脉粥样硬化性疾病方面更有效，72小时内围手术期并发症发生率低，长期卒中和症状性支架内再狭窄。未来需要进行前瞻性随机多中心试验。 Abstract 133: Resolute Stents Less LikelyThan Wingspan To Have Periprocedural Complications With A SignificantImprovement In Long Term Restenosis Rates Ameer Hassan, et, al. Conclusion: Our experience has been thatR-onyx drug-eluting balloon mounted stent is more effective at treating symptomaticintracranial atherosclerotic disease (sICAD) with low rates of periproceduralcomplications within 72 h, long-term strokes, and symptomatic in-stentrestenosis. Future prospective randomized multicenter trials are needed.
17 多取多获益 急性缺血性卒中临床转归和血管内卒中治疗的人群水平趋势 结论：在这个全州性队列中，血管内卒中治疗的使用增加与良好的临床结果呈正相关。这些数据为通过提高血管内治疗获取及利用来改善AIS护理人群的水平提供了证据。 Abstract 134: Population-level Trends In Clinal Outcomes And Endovascular Stroke Therapy In Acute Ischemic Stroke Rania Abdelkhaleq, et, al. Conclusion: In this state-wide cohort,increasing usage of endovascular stroke therapy was positively correlated withexcellent clinical outcomes. These data provide evidence for population-level improvements in AIS care with improving EVT access and utilization.
18 AI分流新系统 Number-needed-to-review：一种评估大血管闭塞检测系统分流效率的新指标 结论：在Rapid LVO中增加凝视和高密度征可增加大脑中动脉M1闭塞的特异性和阳性预测值。当结合Rapid 人工智能软件大血管闭塞（LVO）检测和低或高Tmax>6s阈值时，需要检查的数量显著减少。在卒中分诊中，临床医生每100张中只需手动检查9张影像。 Abstract 135: Number-needed-to-review: A Novel Metric To Assess Triage Efficiency Of Large Vessel Occlusion Detection Systems Joshua Catapano, et, al. Conclusion: The addition of gaze deviationand hyperdense sign to the Rapid LVO increases the specificity and PPV for a M1occlusion. When combined with a negative Rapid AI software large vesselocclusions (LVO) detection and either a low or high Tmax >6s threshold, the number-needed-to-reviewis significantly decreased. As few as 9 images per 100 would be needed to bemanually reviewed by a clinician during stroke triage. 19 未破裂动静脉畸形Aruba试验 Aruba试验对未破裂颅内动静脉畸形的治疗和预后的长期影响 结论：随着Aruba试验的发表，全国范围内未破裂脑动静脉畸形（AVM）的管理实践发生了实质性的变化，持续性和增长性。未破裂AVM介入治疗的住院人数减少，破裂AVM的住院人数相应增加，这与观察等待策略和仅在指数出血事件后治疗的预期一致。 洲说取栓：一项研究改变疾病治疗格局。Aruba Trial, A Randomized Trial of Unruptured Brain AVMs. 相关背景链接：https://beta./study/NCT00389181?patient=ARUBA&locStr=&distance=0 Abstract 136: Long-term Impact Of ArubaTrial On Management And Outcomes Of Unruptured Intracranial ArteriovenousMalformations Smit D Patel, et, al. Conclusion: Nationwide practice inmanagement of unruptured cerebral arteriovenous malformations (AVMs) changedsubstantially with the publication of the ARUBA trial, in a durable andincreasing manner. Fewer admissions with interventional treatment of unrupturedAVMs occurred and a corresponding increase in admission for ruptured AVMstranspired, as expected with a strategy of watchful waiting and treatment onlyafter an index bleeding event. 20 血栓成分与一把通 血栓成分与一把再通有关 结论：血小板在颅内血栓中的比例是一把再通的独立标志物。淋巴细胞和血小板之间的反向关系可能是未来再灌注治疗的目标。 洲说取栓：一把再通，除了取决于技术与材料，有时也是“命”中注定。 Abstract 138: Thrombus Composition IsAssociated With First Pass Recanalization Jesus Juega, et, al. Conclusion: Platelets proportion inintracranial thrombus is an independent marker of first pass recanalization.Inverse relationship between lymphocytes and platelets may be a target forfuture reperfusion treatments
以上为此次大会162篇oral中笔者筛选的取栓研究，各位看官还想看什么，或者需要摘要全文，欢迎留言。 翻译作者：袁正洲 |
|
|
