From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany (G.R.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Inserm Research Center for Epidemiology and Biostatistics, Team Neuroepidemiology, Bordeaux, France (T.K.); and University of Bordeaux, College of Health Sciences, Bordeaux, France (T.K.).
Stroke. 2016 Jun;47(6):1584-92. doi: 10.1161/STROKEAHA.116.012619. Epub 2016 May 5.
In patients with ischemic stroke, randomized trials showed a better functional outcome after endovascular therapy with new-generation thrombectomy devices compared with medical treatment, including intravenous thrombolysis. However, effects on mortality and the generalizability of results to routine clinical practice are uncertain.
In a prospective observational register-based study patients with ischemic stroke treated either with thrombectomy, intravenous thrombolysis, or their combination were included. Primary outcome was the modified Rankin scale score (0 [no symptoms] to 6 [death]) at 3 months. Ordinal logistic regression was used to estimate the common odds ratio as treatment effects (shift analysis). Propensity score matching was applied to compare patients treated either with intravenous thrombolysis alone or with intravenous thrombolysis plus thrombectomy.
Among 2650 recruited patients, 1543 received intravenous thrombolysis, 504 underwent thrombectomy, and 603 received intravenous thrombolysis in combination with thrombectomy. Later time-to-treatment was associated with worse outcomes among patients treated with thrombectomy plus thrombolysis. In 241 pairs of propensity score-matched patients with a proximal intracranial occlusion, thrombectomy plus thrombolysis was associated with improved functional outcome (common odds ratio, 1.84; 95% confidence interval, 1.32-2.57), and reduced mortality (15% versus 33%; P<0.0001) compared with intravenous thrombolysis alone. Results were similar in various sensitivity analyses accounting for missing outcome data and different analytic methods.
Results from this large prospective registry show that also in routine clinical care thrombectomy plus thrombolysis compared with thrombolysis alone improved functional outcome and reduced mortality in patients with ischemic stroke. Earlier treatment was associated with better outcomes.
在缺血性脑卒中患者中，与包括静脉溶栓在内的药物治疗相比，新一代取栓装置的血管内治疗可使患者获得更好的功能结局。然而，其对死亡率的影响以及结果在常规临床实践中的普遍性尚不确定。
本前瞻性观察性基于登记的研究纳入了接受取栓、静脉溶栓或二者联合治疗的缺血性脑卒中患者。主要结局为 3 个月时改良 Rankin 量表评分（0[无症状]至 6[死亡]）。采用有序逻辑回归估计治疗效果（移位分析）的常见比值比。应用倾向评分匹配比较单纯静脉溶栓和静脉溶栓联合取栓的患者。
在 2650 例入选患者中，1543 例接受了静脉溶栓，504 例接受了取栓，603 例接受了静脉溶栓联合取栓。取栓联合溶栓的患者中，治疗时间越晚结局越差。在 241 对近端颅内闭塞的倾向评分匹配患者中，与单纯静脉溶栓相比，取栓联合溶栓可改善功能结局（共同比值比，1.84；95%置信区间，1.32-2.57），降低死亡率（15%比 33%；P<0.0001）。在考虑缺失结局数据和不同分析方法的各种敏感性分析中，结果均相似。
本大型前瞻性登记研究结果表明，在常规临床护理中，与单纯溶栓相比，取栓联合溶栓可改善缺血性脑卒中患者的功能结局，降低死亡率。更早的治疗与更好的结局相关。
