直接血栓切除术或静脉与血管内联合治疗后的结果并无差异。
Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different.
作者信息
Abilleira Sònia, Ribera Aida, Cardona Pedro, Rubiera Marta, López-Cancio Elena, Amaro Sergi, Rodríguez-Campello Ana, Camps-Renom Pol, Cánovas David, de Miquel Maria Angels, Tomasello Alejandro, Remollo Sebastian, López-Rueda Antonio, Vivas Elio, Perendreu Joan, Gallofré Miquel
机构信息
From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain (E.L.-C., S.R.); Department of Neuroscience, Hospital Clínic, Barcelona, Spain (S. Amaro); Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain (A.R.-C.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (P.C.-R.); Neurology Department, Hospital del Parc Taulí, Sabadell, Spain (D.C.); Department of Endovascular Neuroradiology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (M.A.d.M.); Neurointerventional Department, Hospital Vall d'Hebron, Barcelona, Spain (A.T.); Department of Neuroradiology, Hospital Clínic, Barcelona, Spain (A.L.-R.); Department of Interventional Neuroradiology, Hospital del Mar, Barcelona, Spain (E.V.); and Department of Neuroradiology, Hospital del Parc Taulí, Sabadell, Spain (J.P.).
出版信息
Stroke. 2017 Feb;48(2):375-378. doi: 10.1161/STROKEAHA.116.015857. Epub 2017 Jan 6.
BACKGROUND AND PURPOSE
Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.
METHODS
Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel-Haenszel test statistic.
RESULTS
We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74-1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74-1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25-1.27).
CONCLUSIONS
This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
背景与目的
血管内血栓切除术（EVT）前进行静脉溶栓是否能带来更多益处尚不清楚。此外，静脉溶栓会延迟腹股沟穿刺时间，主要是在“点滴注射并转运”的患者中。
方法
利用区域范围内的登记数据，我们选取了2011年1月至2015年10月间接受直接EVT或静脉溶栓联合EVT治疗前循环卒中的病例。通过倾向评分分层来估计治疗效果。使用Mantel-Haenszel检验统计量计算治疗与3个月时良好预后、死亡以及24小时时症状性出血之间关联的平均比值比。
结果
我们纳入了599例直接EVT患者和567例联合治疗患者。通过倾向评分分层实现了各治疗组基线特征的平衡。治疗方式与良好预后（比值比，0.97；95%置信区间，0.74 - 1.27）、死亡（比值比，1.07；95%置信区间，0.74 - 1.54）或症状性出血（比值比，0.56；95%置信区间，0.25 - 1.27）之间均无关联。
结论
这项观察性研究表明，直接EVT或静脉溶栓联合EVT后的结局并无差异。若经随机对照试验证实，这可能会对卒中医疗系统的组织产生重大影响。
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