Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany.
Int J Stroke. 2012 Jan;7(1):14-8. doi: 10.1111/j.1747-4949.2011.00639.x. Epub 2011 Oct 20.
Acute occlusions of the large intracranial arteries are relatively resistant to intravenous thrombolysis. Therefore, multimodal approaches combining intravenous thrombolysis with endovascular mechanical recanalization are increasingly being applied. In this setting, intravenous thrombolysis may facilitate subsequent mechanical thrombectomy. To test this hypothesis, we analyzed the influence of intravenous thrombolysis on net intervention time in subsequent endovascular mechanical recanalization.
In this retrospective single-center analysis, we compared net intervention time with and without preceding intravenous thrombolysis in patients treated by endovascular mechanical recanalization between 01/2003 and 06/2010. The net intervention time was defined as the interval between the onset of endovascular thrombus manipulation and successful vessel recanalization.
We identified 65 eligible patients, 35 of whom were treated by intravenous thrombolysis before mechanical therapy. Recanalization was achieved in 26 patients with (74%) and 23 patients without preceding intravenous thrombolysis (77%). In the case of successful recanalization, the net intervention time was significantly shorter in patients with preceding intravenous thrombolysis (24·8 ± 22·8 vs. 44·2 ± 40·5 min; P<0·05). This difference remained significant after restricting the analysis to the patients treated by the Penumbra Stroke System(©) (n=32). After three-months, patients with preceding intravenous thrombolysis were more likely to be functionally independent (modified Rankin Scale≤2) than those without (P<0·05).
Our findings suggest that preceding intravenous thrombolysis may reduce the intervention time in patients treated by endovascular mechanical recanalization. However, due to the retrospective design of our study, these findings have to be interpreted with caution and need confirmation in a larger patient population.
急性颅内大血管闭塞对静脉溶栓治疗有一定的抵抗性。因此，目前越来越多的采用联合静脉溶栓和血管内机械取栓的多模态方法。在此情况下，静脉溶栓可能有利于后续机械取栓。为了验证这一假说，我们分析了静脉溶栓对后续血管内机械取栓的净介入时间的影响。
在这项回顾性单中心分析中，我们比较了 2003 年 1 月至 2010 年 6 月期间接受血管内机械取栓治疗的患者中，在机械取栓前进行静脉溶栓与未进行静脉溶栓之间的净介入时间。净介入时间定义为血管内血栓操作开始至血管再通成功的时间间隔。
我们共纳入了 65 名符合条件的患者，其中 35 名患者在机械治疗前接受了静脉溶栓。26 名接受静脉溶栓的患者和 23 名未接受静脉溶栓的患者实现了再通（分别为 74%和 77%）。在再通成功的患者中，有静脉溶栓史的患者净介入时间明显更短（24.8±22.8 vs. 44.2±40.5 min；P<0.05）。在限制分析对象为使用 Penumbra Stroke System（©）（n=32）的患者后，这一差异仍然具有统计学意义。在 3 个月时，有静脉溶栓史的患者更有可能功能独立（改良 Rankin 量表评分≤2），而无静脉溶栓史的患者则不然（P<0.05）。
我们的研究结果表明，在接受血管内机械取栓治疗的患者中，静脉溶栓治疗可能会缩短介入时间。然而，由于本研究为回顾性设计，因此这些发现需要谨慎解释，并需要在更大的患者群体中进行验证。
