Song D, Kim B M, Kim D J, Kim Y D, Kim J, Lee H S, Nam H S, Heo J H
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Eur J Neurol. 2014 May;21(5):779-84. doi: 10.1111/ene.12391. Epub 2014 Feb 24.
Although the stent retriever (SR) has shown a better reperfusion rate and clinical outcome than the older generation mechanical clot retrieval device, it is uncertain whether the SR is superior to intra-arterial fibrinolysis (IAF).
Ischaemic stroke patients who were treated with SR or IAF as initial endovascular treatment modality for unilateral arterial occlusion in the anterior circulation were included. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction grade ≥2b. A favourable clinical outcome was defined as a modified Rankin Score ≤2 at 3 months.
Between January 2009 and May 2012, 55 patients were treated with SR and 50 patients were treated with IAF. The baseline characteristics were similar between the two groups except for the occlusion site and rescue treatment. In binary logistic regression analysis adjusted for the occlusion site and rescue treatment, SR was independently associated with increased successful reperfusion [82.0% vs. 47.3%; odds ratio (OR) 5.21; 95% confidence interval (CI) 1.92-14.14) and a more favourable clinical outcome at 3 months (54.0% vs. 43.6%; OR 3.40; 95% CI 1.31-8.84). The frequency of symptomatic intracranial haemorrhage and mortality at 3 months was not different between the two groups.
Stent retriever was as safe as and more effective than IAF. Our findings suggest that SR may be considered as an initial modality rather than IAF in acute stroke patients who undergo endovascular treatment.
尽管支架取栓器（SR）已显示出比上一代机械取栓装置更高的再灌注率和临床疗效，但SR是否优于动脉内溶栓（IAF）仍不确定。
纳入以SR或IAF作为前循环单侧动脉闭塞初始血管内治疗方式的缺血性卒中患者。成功再灌注定义为脑梗死溶栓分级≥2b级。良好的临床疗效定义为3个月时改良Rankin量表评分≤2分。
2009年1月至2012年5月，55例患者接受了SR治疗，50例患者接受了IAF治疗。除闭塞部位和补救治疗外，两组的基线特征相似。在对闭塞部位和补救治疗进行校正的二元逻辑回归分析中，SR与成功再灌注增加独立相关[82.0%对47.3%；优势比（OR）5.21；95%置信区间（CI）1.92 - 14.14]，且在3个月时临床疗效更优（54.0%对43.6%；OR 3.40；95% CI 1.31 - 8.84）。两组3个月时症状性颅内出血的发生率和死亡率无差异。
支架取栓器与IAF一样安全且更有效。我们的研究结果表明，在接受血管内治疗的急性卒中患者中，SR可被视为初始治疗方式而非IAF。
