急性缺血性卒中机械取栓术中动脉内注射阿替普酶溶栓治疗
Intra-Arterial Alteplase Thrombolysis during Mechanical Thrombectomy for Acute Ischemic Stroke.
作者信息
Heiferman Daniel M, Li Daphne D, Pecoraro Nathan C, Smolenski Angela M, Tsimpas Asterios, Ashley William W
机构信息
Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Department of Neurological Surgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
出版信息
J Stroke Cerebrovasc Dis. 2017 Dec;26(12):3004-3008. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.031. Epub 2017 Aug 23.
BACKGROUND
Intra-arterial alteplase (IA tPA) is commonly used during mechanical thrombectomy for acute ischemic stroke in patients with large-vessel occlusion, but specific indications and applications for its use remain undefined.
METHODS
We analyzed 40 patients who underwent stent-retriever mechanical thrombectomy, 28 of whom received adjunctive IA tPA. To our knowledge, this is the largest cohort with this concomitant treatment reported in the literature in the post-mechanical thrombectomy trial era.
RESULTS
Between patients with and without IA tPA, rates of hemorrhagic conversion, neurologic outcome, and mortality were equivalent, with a trend toward improved angiographic revascularization observed in the IA tPA group.
CONCLUSIONS
IA tPA is a safe adjunct to mechanical thrombectomy, and more investigation is warranted to understand ideal indications and dosage methodologies.
背景
动脉内注射阿替普酶（IA tPA）常用于大血管闭塞性急性缺血性卒中患者的机械取栓术中，但对于其具体的适应证和使用方法仍不明确。
方法
我们分析了40例行支架取栓器机械取栓术的患者，其中28例接受了辅助IA tPA治疗。据我们所知，这是机械取栓术后试验时代文献报道的接受这种联合治疗的最大队列。
结果
在接受和未接受IA tPA治疗的患者之间，出血转化、神经功能结局和死亡率相当，IA tPA组的血管造影再通有改善趋势。
结论
IA tPA是机械取栓术的一种安全辅助手段，需要更多研究以了解理想的适应证和给药方法。
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