Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, Khoury J
Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA.
AJNR Am J Neuroradiol. 2008 Mar;29(3):582-7. doi: 10.3174/ajnr.A0843.
Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial.
IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0-2, mortality outcomes, and results from IMS I.
Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter-treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter-treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in IMS I treatments in 23 subjects with reliable 15-minute angiograms (P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and M1 occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion (P = .0004), TICI 2B/3 reperfusion (P = .0002), and arterial occlusive lesion 2/3 recanalization (P = .03).
IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality.
我们的目的是详细阐述卒中介入管理（IMS）II试验中的血管再通结果，包括对预后和死亡率的影响。
IMS II旨在评估在发病3小时内接受治疗的部分缺血性卒中患者中，先给予小剂量静脉注射重组组织型纤溶酶原激活剂（rtPA），随后通过EKOS Primo微输注导管在闭塞部位给予额外动脉内rtPA和低能量超声的疗效和安全性。详细记录血管再通结果，并与改良Rankin量表评分0 - 2、死亡率结果以及IMS I的结果进行比较。
在29例接受超声微导管治疗的闭塞病例中，有12例（41.4%）在60分钟时实现了完全再通。在超声导管治疗组中，20/29例（68.9%）在2小时或手术结束时实现了完全再通，18/29例（62.0%）接受超声治疗的受试者实现了脑梗死最终溶栓（TICI）2/3级再灌注。15分钟血管造影显示，在69/145例（46.7%）超声微导管治疗间隔中有部分再通，而在23例有可靠15分钟血管造影的受试者中，IMS I治疗的39/111例（35.1%）有部分再通（P = .046）。汇总的IMS I - II数据显示，颈内动脉T段和M1段闭塞中，56/75例（74.6%）发生了部分或完全再通，46/75例（61.3%）实现了良好再灌注（TICI 2/3）。血管再通与TICI 2/3再灌注（P = .0004）、TICI 2B/3再灌注（P = .0002）以及动脉闭塞病变2/3再通（P = .03）的良好预后相关。
IMS II提供了证据，表明与标准微导管相比，EKOS Primo超声微导管在闭塞再通方面有改善的趋势，并再次证实了再通与再灌注之间的相关性，以及良好的临床预后和降低的死亡率。
