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Frequency and Predictors of Decompressive Craniectomy in Ischemic Stroke Patients Treated by Mechanical Thrombectomy in the ETIS Registry.

Revue Neurologique(2023)

Ctr Hosp Versailles | Foch Hosp | Rothschild Fdn | Univ Hosp Nancy | Hop Foch | Lille Univ

Cited 0|Views25
Abstract
Background and aims. - Mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) is usually performed in a comprehensive stroke center with on -site neurosurgical expertise. The question of whether MT can be performed in a primary stroke center without a neurosurgical facility is debated. In this context, there is a need to determine the frequency, delay and predictors of neurosurgical procedures in patients treated by MT. This study aims to determine these factors. Methods. - In total, 432 patients under 60 years old, diagnosed with an acute ischemic stroke with a large vessel occlusion and treated by MT between January 2018 and December 2019 in six French stroke centers, were selected from the French clinical registry ETIS. Univariate and multivariate logistic regression models were used to identify predictive factors for decompressive craniectomy. Results. - Among the 432 included patients, 43 (9.9%) patients with an anterior circulation infarct underwent decompressive craniectomy. Higher admission NIHSS (OR: 1.08 [95% CI: 1.02-1.16]), lower ASPECT (OR per 1 point of decrease 1.53 [1.31-1.79] P < 0.001) and preadmission antiplatelet use (OR: 3.03 [1.31-7.01]) were independent risk factors for decompressive craniectomy. The risk of decompressive craniectomy increases to more than 30% with an ASPECT score < 4, an NIHSS > 16, and current antiplatelet use. Conclusion. - In this multicenter registry, 9% of acute ischemic stroke patients ( < 60 years old) treated with MT, required decompressive craniectomy. Higher NIHSS score, lower ASPECT score, and preadmission antiplatelet use increase the risk of subsequent requirement for decompressive craniectomy. (c) 2023 Elsevier Masson SAS. All rights reserved.
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Malignant cerebral infarct,Decompressive craniectomy,Endovascular treatment
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要点】:研究通过法国ETIS临床注册数据,分析了接受机械性血栓切除术治疗的急性缺血性脑卒中患者中,减压性颅骨切除手术的发生频率及其预测因素,发现高 NIHSS 评分、低 ASPECT 评分和术前抗血小板药物使用是独立的风险因素。

方法】:采用单变量和多变量逻辑回归模型分析患者特征,以确定与减压性颅骨切除手术相关的预测因子。

实验】:研究纳入了2018年1月至2019年12月间在六个法国卒中中心接受MT治疗的432名60岁以下、大血管闭塞的急性缺血性脑卒中患者,通过ETIS注册数据进行分析,得出减压性颅骨切除手术的发生率为9.9%。