2211-968X/$ — see front matter ? 2012 Elsevier GmbH. All rights reserved.
doi:10.1016/j.permed.2012.02.064
Ruud W.M. Keunena,?, Agnes van Sonderena, Maayke Hunfelda,
Michael Remmersb, D.L. Tavya, S.F.T.M. de Bruijna, A. Moscha
a Department of Neurology and Clinical Neurophysiology, Haga Teaching Hospitals, The Hague, The Netherlands
b Department of Neurology, Amphia Hospital, Breda, The Netherlands
Summary
Background: Current protocols stress the importance of short-term diagnosis and treatmentin recent TIA or minor stroke. The risk of a recurrent event can be predicted with embolus detection. Studies have shown that the presence of micro-emboli is associated with an increased risk of recurrent events. We explored in our patient population the effect of a zero-tolerance regime for cerebral embolism on outcome.
Methods: Patients with a recent TIA or minor stroke were assigned to a study group or control group. Both groups were treated according to European Stroke guidelines, including prompt start of anti-thrombotic therapy, statins and short-term carotid arteries duplex scanning. The
study group was subjected to TCD (Delica 9 series, Shenzen Delicate Electronics Co., LTD.,China)embolus detection as soon as possible (EDS, SMT Medical, Wuerzburg, Germany). If emboli were detected, treatment was started immediately to stop cerebral embolization. This was achieved by either an altered drug regimen (clopidogrel) or angioplasty or carotid endarterectomy within one or two days. If carotid intervention was indicated in the control group, it was performed within two weeks, according to European guidelines.
Results: 133 patients were enrolled in the study with three months follow-up. 61 patients were subjected to the control group, 72 patients were enrolled in the study group. Recurrent events occurred in 10.2% and 3.0%, respectively (p = 0.145).
Conclusion: The current study shows a non-significant reduction in recurrent events in the study group. Probably sample size in this pilot study was insufficient to detect a significant decline.Nevertheless, the results show that embolus detection is feasible and the zero-tolerance regimemay enhance the outcome of TIA and minor stroke patients. The findings support the start of a multicenter randomized trial to assess the clinical value of emboli detection in TIA and stroke care.
摘要
背景：目前的方案強(qiáng)調(diào)了短期診斷和治療的重要性在最近的TIA或輕度中風(fēng)中。栓塞可預(yù)測復(fù)發(fā)事件的風(fēng)險(xiǎn)檢測。研究表明，微栓塞的存在與增加復(fù)發(fā)事件的風(fēng)險(xiǎn)。我們在患者人群中探索了零容忍的影響腦栓塞治療的結(jié)局。
方法：將近期有TIA或輕度卒中的患者分配到研究組或?qū)φ战M組。兩組均按照歐洲卒中指南進(jìn)行治療，包括及時(shí)開始抗血栓治療，他汀類藥物和短期頸動(dòng)脈雙工掃描。的
研究組接受了TCD（Delica 9系列，深圳市德力凱醫(yī)療設(shè)備股份有限公司，中國）盡早發(fā)現(xiàn)栓子（EDS，SMT Medical，德國維爾茨堡）。如果栓子進(jìn)行檢測后，立即開始治療以停止腦栓塞。這是通過改變藥物治療方案（氯吡格雷）或血管成形術(shù)或頸動(dòng)脈內(nèi)膜切除術(shù)可以達(dá)到一兩天內(nèi)。如果對(duì)照組中有頸動(dòng)脈介入治療，那就是根據(jù)歐洲指南在兩周內(nèi)進(jìn)行了檢查。
結(jié)果：133名患者被納入研究，并進(jìn)行了三個(gè)月的隨訪。 61例對(duì)照組為72例患者。周期性事件發(fā)生率分別為10.2％和3.0％（p = 0.145）。
結(jié)論：目前的研究表明該研究中復(fù)發(fā)事件的減少無統(tǒng)計(jì)學(xué)意義組。這項(xiàng)初步研究的樣本量可能不足以檢測出明顯的下降。盡管如此，結(jié)果表明栓塞檢測是可行的，零容忍制度可能會(huì)增強(qiáng)TIA和輕度卒中患者的預(yù)后。研究結(jié)果支持多中心隨機(jī)試驗(yàn)評(píng)估TIA和中風(fēng)中栓子檢測的臨床價(jià)值關(guān)心。（譯文來自GOOGLE)
