目的研究急性血栓性和心源性栓塞性大脑中动脉闭塞(MCAO)的临床特点的差异。方法选择5年内急诊住院的被磁共振血管成像(MRA)证实为急性大脑中动脉M1段急性闭塞的患者67例,其中血栓组45例,栓塞组22例,在未接受溶栓治疗的情况下,比较分析...目的研究急性血栓性和心源性栓塞性大脑中动脉闭塞(MCAO)的临床特点的差异。方法选择5年内急诊住院的被磁共振血管成像(MRA)证实为急性大脑中动脉M1段急性闭塞的患者67例,其中血栓组45例,栓塞组22例,在未接受溶栓治疗的情况下,比较分析两种病因导致的MCAO患者危险因素,入院时及发病后14 d NIHSS评分,出血性转化发生率。结果血栓性MCAO患者年龄小于栓塞性MCAO患者;入院当日血栓形成患者NIHSS评分(6.42±3.38)显著小于栓塞性患者(11.67±8.50),P<0.01,14 d时这种差别仍然存在;栓塞组出血性转化率显著高于血栓形成组。结论栓塞性MCAO患者发病年龄大,临床症状重,预后不良,强烈建议开展超早期的动脉溶栓。展开更多
Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention(PCI) in acute myocardial infarction is common and may result in microcirculatory dysfunction, the prevention of which may imp...Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention(PCI) in acute myocardial infarction is common and may result in microcirculatory dysfunction, the prevention of which may improve reperfusion success, reduce infarct size, and enhance event-free survival. Objective: To determine whether protection of the distal microcirculation from thromboembolic debris liberated during primary PCI results in improved reperfusion and decreased infarct size. Design, Setting, and Patients: Prospective randomized controlled trial at 38 academic and community-based institutions in 7 countries enrolling 501 patients aged 18 years or older with ST-segment elevation myocardial infarction(STEMI) presenting within 6 hours of symptom onset and undergoing primary PCI or rescue intervention after failed thrombolysis. Interventions: Patients were randomized between May 20, 2002, and November 21, 2003, to receive PCI with a balloon occlusion and aspiration distal microcirculatory protection systemvs angioplasty without distal protection. Main Outcome Measures: Coprimary end points were ST-segment resolution(STR) measured 30 minutes after PCI by continuous Holter monitoring and infarct size measured by technetium Tc 99m sestamibi imaging between days 5 and 14. Secondary end points included major adverse cardiac events. Results: Among 252 patients assigned to distal protection, aspiration was performed in 97%(242/251), all angioplasty balloon inflations were fully protected in 79%(193/245), and visible debris was retrieved from 73%(182/250). Complete STR was achieved in a similar proportion reperfused with vs without distal protection(63.3%[152/240] vs 61.9%[148/239], respectively; absolute difference, 1.4%[95%confidence interval,-7.7%to 10.5%; P=.78]), and left ventricular infarct size was similar in both groups(median, 12.0%[n=229] vs 9.5%[n=208], respectively; P=.15). Major adverse cardiac events at 6 months occurred with similar frequency in the distal protection and control groups(10.0%vs 11.0%, res展开更多
文摘目的研究急性血栓性和心源性栓塞性大脑中动脉闭塞(MCAO)的临床特点的差异。方法选择5年内急诊住院的被磁共振血管成像(MRA)证实为急性大脑中动脉M1段急性闭塞的患者67例,其中血栓组45例,栓塞组22例,在未接受溶栓治疗的情况下,比较分析两种病因导致的MCAO患者危险因素,入院时及发病后14 d NIHSS评分,出血性转化发生率。结果血栓性MCAO患者年龄小于栓塞性MCAO患者;入院当日血栓形成患者NIHSS评分(6.42±3.38)显著小于栓塞性患者(11.67±8.50),P<0.01,14 d时这种差别仍然存在;栓塞组出血性转化率显著高于血栓形成组。结论栓塞性MCAO患者发病年龄大,临床症状重,预后不良,强烈建议开展超早期的动脉溶栓。
文摘Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention(PCI) in acute myocardial infarction is common and may result in microcirculatory dysfunction, the prevention of which may improve reperfusion success, reduce infarct size, and enhance event-free survival. Objective: To determine whether protection of the distal microcirculation from thromboembolic debris liberated during primary PCI results in improved reperfusion and decreased infarct size. Design, Setting, and Patients: Prospective randomized controlled trial at 38 academic and community-based institutions in 7 countries enrolling 501 patients aged 18 years or older with ST-segment elevation myocardial infarction(STEMI) presenting within 6 hours of symptom onset and undergoing primary PCI or rescue intervention after failed thrombolysis. Interventions: Patients were randomized between May 20, 2002, and November 21, 2003, to receive PCI with a balloon occlusion and aspiration distal microcirculatory protection systemvs angioplasty without distal protection. Main Outcome Measures: Coprimary end points were ST-segment resolution(STR) measured 30 minutes after PCI by continuous Holter monitoring and infarct size measured by technetium Tc 99m sestamibi imaging between days 5 and 14. Secondary end points included major adverse cardiac events. Results: Among 252 patients assigned to distal protection, aspiration was performed in 97%(242/251), all angioplasty balloon inflations were fully protected in 79%(193/245), and visible debris was retrieved from 73%(182/250). Complete STR was achieved in a similar proportion reperfused with vs without distal protection(63.3%[152/240] vs 61.9%[148/239], respectively; absolute difference, 1.4%[95%confidence interval,-7.7%to 10.5%; P=.78]), and left ventricular infarct size was similar in both groups(median, 12.0%[n=229] vs 9.5%[n=208], respectively; P=.15). Major adverse cardiac events at 6 months occurred with similar frequency in the distal protection and control groups(10.0%vs 11.0%, res
