Safety, feasibility, and potential efficacy of intraarterial selective cooling infusion for stroke patients treated with mechanical thrombectomy
Safety, feasibility, and potential efficacy of intraarterial selective cooling infusion for stroke patients treated with mechanical thrombectomy
复制标题
动脉内选择性冷却输注治疗接受机械取栓治疗的脑卒中患者的安全性、可行性和潜在疗效
DOI：
10.1177/0271678x18790139
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发表时间：
2018-12-01
影响因子：
6.3
通讯作者：
Ji, Xunming
中科院分区：
文献类型：
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作者：
Wu, Chuanjie;Zhao, Wenbo;Ji, Xunming
这是一项纳入113例连续患者的前瞻性非随机队列研究，旨在研究靶向缺血区域的短期动脉内选择性冷却输注（IA-SCI）联合机械血栓切除术（MT）治疗大血管闭塞诱导的急性缺血性卒中（AIS）患者的安全性和有效性; 45/113例患者接受了IA-SCI，根据介入医生的判断，在4℃下使用350 ml 0.9%生理盐水持续15分钟。两组之间的关键参数，如生命体征和关键实验室值、症状性和任何颅内出血、凝血异常、肺炎、尿路感染和死亡率无显著差异。最终梗死体积（FIV）在3 - 7天的非增强CT上进行评估。经调整回归分析后，FIV的组间差异（19.1 ml; 95%置信区间（CI）3.2至25.2; P = 0.038）显著有利于IA-SCI组。在90天时，未发现达到功能独立（mRS 0-2）的患者比例存在差异（51.1% vs. 41.2%，校正比值比（aOR）1.9，95%CI 0.8-2.6，P = 0.192）。短期IA-SCI联合MT治疗是安全的。有一个较小的FIV和临床获益的趋势，需要在随机对照试验中进一步评估。
This is a prospective non-randomized cohort study of 113 consecutive patients to investigate the safety and efficacy of a short-duration intraarterial selective cooling infusion (IA-SCI) targeted into an ischemic territory combined with mechanical thrombectomy (MT) in patients with large vessel occlusion-induced acute ischemic stroke (AIS); 45/113 patients underwent IA-SCI with 350 ml 0.9% saline at 4℃ for 15 min at the discretion of the interventionalist. Key parameters such as vital signs and key laboratory values, symptomatic and any intracranial hemorrhage, coagulation abnormalities, pneumonia, urinary tract infections and mortality were not significantly different between the two groups. Final infarct volume (FIV) was assessed on noncontrast CT performed at three to seven days. After an adjusted regression analysis, the between-group difference in FIV (19.1 ml; 95% confidence interval (CI) 3.2 to 25.2; P = 0.038) significantly favored the IA-SCI group. At 90 days, no differences were found in the proportion of patients who achieved functional independence (mRS 0–2) (51.1% versus. 41.2%, adjusted odd ratio (aOR) 1.9, 95% CI 0.8–2.6, P = 0.192). Combining short-duration IA-SCI with MT was safe. There was a smaller FIV and trend towards clinical benefit that will need to be further evaluated in randomized control trials.