Comprehensive Stroke Center, Department of Neurology, Faculty of Medicine, Ostrava University and University Hospital Ostrava, 17 Listopadu 1790, CZ-708 52 Ostrava-Poruba, Czech Republic.
Radiology. 2013 Mar;266(3):871-8. doi: 10.1148/radiol.12120798. Epub 2012 Dec 11.
To compare safety and utility of intraarterial revascularization with use of stents to no revascularization in patients who either failed to respond to intravenous thrombolysis (IVT) or have contraindications to IVT.
The case-control study was approved by local ethics committees; all patients signed informed consent. One hundred thirty-one patients (74 men; mean age, 65.9 years ± 12.3; range, 25-86 years) with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion were enrolled; 75 underwent IVT. No further recanalization therapy was performed in 26 (35%) IVT-treated patients with MCA recanalization (group 1). Patients with IVT failure after 60 minutes were allocated to endovascular treatment (group 2A) or no further therapy (group 2B). Patients with contraindication to IVT were allocated to endovascular treatment within 8 hours since AIS onset (group 3A) or to no recanalization therapy (group 3B). Neurologic deficit at admission, MCA recanalization, symptomatic intracerebral hemorrhage (SICH), and 3-month clinical outcome were evaluated. Favorable clinical outcome was defined as modified Rankin scale score 0-2 at 3 months after stroke onset. Two-sided Mann-Whitney U test, independent samples t test, Fisher exact test, multivariate logistic regression analysis of baseline variables, and complete MCA recanalization for the prediction of favorable clinical outcome were used for statistical evaluation.
Median National Institutes of Health Stroke Scale score at admission was 13.5, 16.0, 15.5, 15.0, and 16.0 in groups 1, 2A, 2B, 3A, and 3B, respectively (P > .05); SICH occurred in one of 26 (3.8%), one of 23 (4.3%), one of 26 (3.8%), one of 31 (3.2%), and one of 25 (4.0%) patients, respectively (P > .05). MCA recanalization after endovascular treatment was achieved in 50 of 54 (92.6%) patients. Favorable outcome was significantly different between groups 2A and 2B (10 of 23 [43.5%] and four of 26 [15.4%], respectively; P = .03) and groups 3A and 3B (14 of 31 [45.2%] and two of 25 [8.0%], respectively; P = .004) and was dependent on MCA recanalization (odds ratio, 5.55; P = .006).
In this controlled trial, intraarterial revascularization with stents was an effective and safe-effective treatment option in patients with acute MCA occlusion with contraindication to IVT or after IVT failure.
比较急性大脑中动脉（MCA）闭塞患者在接受静脉溶栓（IVT）失败或存在 IVT 禁忌证时，采用支架进行动脉内血管再通与不进行血管再通的安全性和效果。
本病例对照研究经当地伦理委员会批准，所有患者均签署了知情同意书。共纳入 131 例因 MCA 闭塞导致急性缺血性脑卒中（AIS）的患者（74 例男性；平均年龄 65.9 岁±12.3 岁；范围 25-86 岁），75 例接受了 IVT。26 例（35%）接受 IVT 治疗的 MCA 再通患者（组 1）未进一步进行再通治疗。IVT 后 60 分钟再通失败的患者被分配至血管内治疗（组 2A）或不进行进一步治疗（组 2B）。有 IVT 禁忌证的患者在 AIS 发病后 8 小时内被分配至血管内治疗（组 3A）或不进行再通治疗（组 3B）。评估患者入院时的神经功能缺损、MCA 再通、症状性颅内出血（SICH）和 3 个月的临床转归。良好的临床转归定义为发病后 3 个月改良 Rankin 量表评分为 0-2。采用双侧 Mann-Whitney U 检验、独立样本 t 检验、Fisher 确切概率法、多变量逻辑回归分析基线变量和完全 MCA 再通对良好临床转归的预测作用进行统计学评估。
组 1、2A、2B、3A 和 3B 患者入院时的美国国立卫生研究院卒中量表评分中位数分别为 13.5、16.0、15.5、15.0 和 16.0（P＞.05）；SICH 分别发生于 1 例（3.8%）、1 例（4.3%）、1 例（3.8%）、1 例（3.2%）和 1 例（4.0%）患者（P＞.05）。54 例患者中有 50 例（92.6%）在血管内治疗后实现 MCA 再通。组 2A 和 2B 之间（10 例[43.5%]和 4 例[15.4%]）和组 3A 和 3B 之间（14 例[45.2%]和 2 例[8.0%]）的良好临床转归率差异有统计学意义（P=.03 和 P=.004），且与 MCA 再通相关（比值比，5.55；P=.006）。
在这项对照试验中，对于存在 IVT 禁忌证或 IVT 失败的急性 MCA 闭塞患者，支架动脉内血管再通是一种有效且安全有效的治疗选择。
