大血管缺血性卒中后血管内血栓切除术：美国的应用、结果和再入院

大血管缺血性卒中后血管内血栓切除术：美国的应用、结果和再入院



摘要

背景：在发表了证明血栓切除术有效性的试验后，2015年修订了社会指南，建议对大血管卒中采用这种方法。目的评估美国急性脑卒中大规模血栓切除术后2年内血栓切除率、不良事件、转归和再入院率。材料与方法在这项回顾性研究中，作者查询了2016年至2017年间接受血栓切除术患者的全国住院样本和全国再入院数据库。血栓切除率比较采用χ2检验。采用多变量Poisson回归和医院层面的聚类分析，获得影响常规出院、死亡率和再入院的因素的校正风险比（aRRs）。结果共收治颈内动脉或大脑中动脉卒中患者290460例（平均年龄70.5±14.2岁，女性148620例），其中30835例（10.6%）行血栓切除术。90岁或以上患者的血栓切除率较低（24090例患者中1815例，占7.5%），黑人患者（43365例患者中4280例，占9.9%），收入最低的患者（85905例患者中8520例，占9.9%）和在西南部中心区医院治疗的患者（34355例患者中2695例，占7.8%）（P<0.001）。住院病死率为12.1%（30835例中3740例），出院率为19.1%（30835例中5900例）。在校正分析中，90岁或以上的患者（aRR:0.12；95%CI:0.09,0.16；P<0.001）和80岁以上的患者（aRR:0.37；95%CI:0.33,0.41；P<0.001）常规出院的可能性较小。90岁或以上的患者（aRR:1.78；95%CI:1.48，2.14；P<0.001）、80岁以上的老人（aRR:1.76；95%CI:1.51，2.06；P<0.001）、亚洲人和/或太平洋岛民（aRR:1.21；95%CI:1.06，1.39；P=0.005）以及在教学中接受治疗的患者（aRR:1.20；95%CI:1.07，1.34；P=0.001）或在中南部接受治疗的患者（aRR:1.35；95%CI:1.14，1.60）；P<0.001）医院有较高的死亡风险。出院后，18.9%的患者（18274例中的3449例）在90天内再次入院。结论血栓切除率和结果受人口统计学、社会经济和医院相关因素的影响。不到五分之一的患者出院回家，近五分之一的患者在90天内再次入院，死亡率和预后可能不如已发表的试验。©RSNA，2021在线补充材料可用于本文。Radiology

. 2021 Feb 16;203082.

 doi: 10.1148/radiol.2021203082. Online ahead of print.

Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United States

Pedram Golnari 1, Pouya Nazari 1, Sameer A Ansari 1, Michael C Hurley 1, Ali Shaibani 1, Matthew B Potts 1, Babak S Jahromi 1

Affiliations expand

• PMID: 33591890

•  

• DOI: 10.1148/radiol.2021203082

Abstract

Background Following publication of trials demonstrating the efficacy of thrombectomy, societal guidelines were revised in 2015 to recommend this procedure for large-vessel stroke. Purpose To evaluate real-world thrombectomy rates, adverse events, outcomes, and readmissions across the United States in the 2 years after large-scale adoption of thrombectomy for acute stroke. Materials and Methods In this retrospective study, the authors queried the National Inpatient Sample and Nationwide Readmissions Database for patients undergoing thrombectomy between 2016 and 2017. Thrombectomy rates were compared by using the χ2 test. Adjusted risk ratios (aRRs) were obtained for factors affecting routine discharge, mortality, and readmission by using multivariable Poisson regression with clustering at the hospital level. Results There were 290 460 admissions (mean age, 70.5 years ± 14.2 [standard deviation]; 148 620 women) for internal carotid or middle cerebral artery stroke; 30 835 (10.6%) of these patients underwent thrombectomy. Thrombectomy rates were lower in patients aged 90 years or older (1815 of 24 090 patients, 7.5%), Black patients (4280 of 43 365 patients, 9.9%), patients with the lowest income (8520 of 85 905 patients, 9.9%), and those treated in West South Central division hospitals (2695 of 34 355 patients, 7.8%) (P < .001 for all). The inpatient mortality rate was 12.1% (3740 of 30 835 patients), and 19.1% of patients (5900 of 30 835) were discharged to home. In adjusted analyses, routine discharge was less likely in patients aged 90 years or older (aRR: 0.12; 95% CI: 0.09, 0.16; P < .001) and octogenarians (aRR: 0.37; 95% CI: 0.33, 0.41; P < .001). Patients aged 90 years or older (aRR: 1.78; 95% CI: 1.48, 2.14; P < .001), octogenarians (aRR: 1.76; 95% CI: 1.51, 2.06; P < .001), Asians and/or Pacific Islanders (aRR: 1.21; 95% CI: 1.06, 1.39; P = .005), and those treated in teaching (aRR: 1.20; 95% CI: 1.07, 1.34; P = .001) or West South Central division (aRR: 1.35; 95% CI: 1.14, 1.60; P < .001) hospitals had a higher risk of death. Following discharge, 18.9% of patients (3449 of 18 274) were readmitted within 90 days. Conclusion Rates and outcomes of thrombectomy are affected by demographic, socioeconomic, and hospital-related factors. Fewer than one-fifth of patients are discharged to home, nearly one-fifth are readmitted within 90 days, and mortality and outcomes may be less favorable than in published trials. © RSNA, 2021 Online supplemental material is available for this article.

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