Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
World Neurosurg. 2010 Oct-Nov;74(4-5):455-64. doi: 10.1016/j.wneu.2010.06.035. Epub 2011 Jan 12.
To report results of endovascular therapy for acute ischemic stroke (AIS) in patients who were not candidates for intravenous thrombolysis (IVT) or in whom IVT failed.
Prospectively collected data for patients treated between January 2006 and June 2009 were analyzed retrospectively. After careful patient and therapy selection, 213 AIS patients with a mean NIHSS score of 14.2 at presentation underwent intervention. End points analyzed were Thrombolysis in Myocardial Infarction (TIMI) 2/3 reperfusion, symptomatic intracranial hemorrhage (SICH) rates, and 90-day outcomes (modified Rankin Scale [mRS] and mortality). Multivariate binary logistic regression analysis was used to assess independent predictors of end points.
Of 189 patients with anterior circulation occlusions, 135 were treated within 0-8 hours, 33 were treated after 8 or more hours, and 21 were treated after wake-up stroke (WUS). Among 24 patients treated with posterior circulation occlusions, 4 had WUS. After treatment, 72.3% patients had TIMI 2/3 reperfusion; SICH rate was 8.7%; at 90 days, 36.6% recovered to mRS 2 or less. SICH rate was higher in patients with anterior circulation strokes who received treatment 8 or more hours after symptom onset (odds ratio [OR] = 3.8) and patients with WUS (OR = 4.9). In patients treated within 8 hours of onset of symptoms of anterior circulation stroke, SICH rate was only 6.7%. There was no difference in outcomes in patients with WUS compared with patients treated less than 8 hours after stroke onset.
This is the first and largest prospective study to the authors' knowledge that shows endovascular therapy for AIS patients in a real-world setting. High recanalization rates with low SICH rates were achieved using careful patient and therapy selection.
报告不适合静脉溶栓（IVT）或 IVT 失败的急性缺血性卒中（AIS）患者的血管内治疗结果。
回顾性分析 2006 年 1 月至 2009 年 6 月期间治疗的患者的前瞻性收集数据。经过仔细的患者和治疗选择，213 名 AIS 患者在就诊时的 NIHSS 评分为 14.2，接受了介入治疗。分析的终点包括血栓形成溶栓（TIMI）2/3 再灌注、症状性颅内出血（SICH）发生率和 90 天结局（改良 Rankin 量表[mRS]和死亡率）。多变量二元逻辑回归分析用于评估终点的独立预测因素。
在 189 例前循环闭塞患者中，135 例在 0-8 小时内治疗，33 例在 8 小时或更长时间后治疗，21 例在醒后卒中（WUS）后治疗。24 例后循环闭塞患者中，4 例为 WUS。治疗后，72.3%的患者出现 TIMI 2/3 再灌注；SICH 发生率为 8.7%；90 天时，36.6%的患者恢复至 mRS 2 级或以下。症状发作后 8 小时或以上接受治疗的前循环卒中患者（比值比[OR] = 3.8）和 WUS 患者（OR = 4.9）SICH 发生率较高。在前循环卒中症状发作后 8 小时内接受治疗的患者中，SICH 发生率仅为 6.7%。与发病后 8 小时内接受治疗的患者相比，WUS 患者的结局无差异。
这是作者所知的第一项也是最大的前瞻性研究，表明在真实环境中对 AIS 患者进行血管内治疗。通过仔细的患者和治疗选择，实现了高再通率和低 SICH 率。
