Carvalho Andreia, Cunha André, Rodrigues Marta, Figueiredo Sofia, Paredes Ludovina, Gregório Tiago, Morais Hugo, Pinheiro Joaquim, Cruz Vítor Tedim, Roriz José Mário, Pinho João, Ferreira Carla, Torre Edgar, Nunes Joana, Castro Sérgio, Ribeiro Manuel, Veloso Miguel, Barros Pedro
Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Imagiology Department, Neuroradiology Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):589-594. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.116. Epub 2016 Dec 27.
Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting?
We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative.
Our study population of 77 patients, with a mean age of 68,2 years and 48,1% men, is comparable with these trials in much of selection criteria, baseline characteristics, and rate of previous intravenous thrombolysis (72,7%). Recovery of functional independence at 90 days was achieved in almost two thirds of patients, similarly to the referred trials. We devoted special emphasis on fast recanalization, keeping a simple image selection protocol (based on non-enhanced and computed tomography angiography) and not waiting for clinical response to thrombolysis in patients eligible for mechanical thrombectomy. We emphasize a successful recanalization rate of 87% and only 2,6% symptomatic intracranial hemorrhage.
In summary, mechanical thrombectomy seems to be a safe and effective treatment option in a "real-world" scenario, with results similar to those of the recent randomized controlled trials.
直到最近，静脉溶栓仍是急性缺血性脑卒中患者唯一经证实有效的再灌注治疗方法。然而，这种治疗方案在大血管闭塞中的再通率较低。对其他治疗方法的探索一直在继续，直到5项随机试验（MR CLEAN、ESCAPE、EXTEND-IA、SWIFT PRIME和REVASCAT）显示，机械取栓术治疗前循环大血管闭塞具有优越性。在我们的三级医院使用支架取栓器进行取栓术1年后，我们试图回答这个问题：在“现实世界”中能否取得类似的结果？
我们分析了前瞻性观察登记的数据，将其与上述试验进行比较，得出的答案是肯定的。
我们的研究队列包括77例患者，平均年龄68.2岁，男性占48.1%，在许多选择标准、基线特征和既往静脉溶栓率（72.7%）方面与这些试验具有可比性。近三分之二的患者在90天时恢复了功能独立性，与上述试验相似。我们特别强调快速再通，保持简单的影像选择方案（基于非增强CT和CT血管造影），对于适合机械取栓的患者不等待溶栓的临床反应。我们强调成功再通率为87%，有症状颅内出血仅占2.6%。
总之，在“现实世界”的情况下，机械取栓术似乎是一种安全有效的治疗选择，其结果与近期随机对照试验相似。
