The effect of suction therapy on older patients with malignant middle cerebral artery occlusion
10.3760/cma.j.issn.1671-0282.2024.12.008
- VernacularTitle:抽吸治疗老年恶性大脑中动脉梗死的效果
- Author:
Quan CHEN
1
;
Xi ZHANG
;
Zhenjie SUN
;
Shu WANG
;
Hang WU
;
Yijun DENG
;
Jinbiao LUO
;
Shujie SUN
;
Aidong ZHENG
;
Maogang CHEN
Author Information
1. 淮安市第一人民医院神经内科，淮安 223001
- Keywords:
Malignant cerebral middle artery infarction;
Large hemispheric infarction;
Decompressive hemicraniectomy;
Stereotactic aspiration;
Elderly;
Minimally invas
- From:
Chinese Journal of Emergency Medicine
2024;33(12):1710-1719
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect and safety of stereotactic aspiration of necrotic brain tissue for the patients≥61 years with malignant middle cerebral artery infarction (MMI).Methods:A total of 102 MMI patients aged≥61 years were enrolled retrospectively. All patients were subject to conservative medical treatment alone or in addition to stereotactic aspiration of necrotic brain tissue 24-72 hours after symptom onset. Perioperative outcomes and 6-month follow-up outcomes were observed and evaluated.Results:Baseline data characteristics were well balanced between the conservative treat group and aspiration group, except for the prevalence of hypertension. The incidence of early cerebral herniation (9.1% vs. 48.3%, χ2=17.843, P<0.001) and death (13.6% vs. 60.3%, χ2=22.707, P<0.001)in the aspiration group was significantly lower than that in the conservative group, and there was no significant difference in the incidence of cerebral hemorrhage ( P=0.726) and intracranial infection ( P=0.186) between the groups. At 6-month follow-up, compared with the conservative treatment group, the aspiration group had a higher proportion of favorable outcome (mRS 0-3) (38.6% vs. 3.4%, χ2 =20.438, P<0.001) and survival without severe disability (mRS 0-4) (68.2% vs. 22.4%, χ2=21.492, P<0.001). Comparison of clinical characteristics of favorable outcome (mRS 0-3) group and unfavorable (mRS 4-6) group showed that the proportion of patients treated with aspiration was significantly higher than that treated with medical therapy alone (89.5% vs. 10.5%, P<0.001). Multivariate logisitic regression used to adjust the confound factors such as atrial fibrillation, diabetes and smoking, the GCS and the NIHSS score of 24 hours after onset, etc, revealed that the treatment with aspiration was an independent association factor for the ratio of 6-month favorable outcome for the elderly patients with MMI ( OR=126.704, 95% CI: 7.236-2218.610, P<0.001). Conclusions:The stereotactic aspiration of necrotic brain tissue are effective and safe for the elderly patients with MMI.
