Interventional Neuroradiology, West Virginia University Hospital, Morgantown, WV 26508,USA.
J Neurointerv Surg. 2013 Sep 1;5(5):430-4. doi: 10.1136/neurintsurg-2012-010429. Epub 2012 Jul 28.
We compared outcomes between endovascular (EV) therapy and intravenous (IV) thrombolysis in large vessel strokes.
223 patients who had received either IV (n=100) or EV (n=123) therapy were analyzed. Only patients with strokes involving the internal carotid artery terminus (ICA-T, n=45), the middle cerebral artery (M1, n=107) or the bifurcation branches (M2, n=71) were included. The primary endpoint was 3 month outcome based on the modified Rankin Scale (mRS) score, good-outcome defined as mRS ≤2.
The good outcome was 44.7% in the EV group and 26% in the IV group (p=0.003, OR 2.3, 95% CI 1.3 to 4.1). There was no difference in mortality or hemorrhage. For ICA-T occlusions, the good outcome was 27.6% in the EV and 0% in the IV group (p=0.004); for M1 occlusions, 40.6% in the EV versus 10.5% in the IV group (p=0.0006, OR 5.8, 95% CI 1.9 to 18.2); and for M2 occlusions, 76% in the EV versus 47.8% in the IV group (p=0.01, OR 3.5, 95% CI 1.2 to 10.2). For M1 occlusions, the death rate was 27.5% for the EV compared with 57.9% for the IV group (p=0.002, OR 3.6, 95% CI 1.6 to 8.3) with no difference observed in mortality for ICA-T or M2 occlusions. In the univariate analysis, age, National Institutes of Health Stroke Scale score and occlusion site were significant predictors of outcome and mortality (p<0.0001 for all). In the multivariable analysis, EV therapy (p=0.0004, OR 3.9, 95% CI 1.8 to 9) and younger age (p<0.0001, OR 0.96, 95% CI 0.9 to 0.98) were significant independent predictors of good outcome.
There are significantly higher odds of a favorable outcome with EV compared with IV therapy for large vessel strokes. The data support the rationale of a randomized trial for large vessel occlusions.
我们比较了血管内（EV）治疗和静脉内（IV）溶栓治疗大动脉卒患者的结局。
分析了 223 例接受 IV（n=100）或 EV（n=123）治疗的患者。仅纳入涉及颈内动脉终末段（ICA-T，n=45）、大脑中动脉（M1，n=107）或分叉支（M2，n=71）的卒患者。主要终点是基于改良 Rankin 量表（mRS）评分的 3 个月结局，良好结局定义为 mRS≤2。
EV 组的良好结局为 44.7%，IV 组为 26%（p=0.003，OR 2.3，95%CI 1.3 至 4.1）。两组死亡率或出血率无差异。ICA-T 闭塞患者 EV 组的良好结局为 27.6%，IV 组为 0%（p=0.004）；M1 闭塞患者 EV 组为 40.6%，IV 组为 10.5%（p=0.0006，OR 5.8，95%CI 1.9 至 18.2）；M2 闭塞患者 EV 组为 76%，IV 组为 47.8%（p=0.01，OR 3.5，95%CI 1.2 至 10.2）。M1 闭塞患者 EV 组的死亡率为 27.5%，IV 组为 57.9%（p=0.002，OR 3.6，95%CI 1.6 至 8.3），ICA-T 或 M2 闭塞患者死亡率无差异。单因素分析显示，年龄、国立卫生研究院卒中量表评分和闭塞部位是结局和死亡率的显著预测因素（p<0.0001）。多变量分析显示，EV 治疗（p=0.0004，OR 3.9，95%CI 1.8 至 9）和年龄较小（p<0.0001，OR 0.96，95%CI 0.9 至 0.98）是良好结局的独立显著预测因素。
与 IV 治疗相比，EV 治疗大动脉卒患者的结局显著更好。数据支持对大动脉闭塞患者进行随机试验的理由。
