Cabral Norberto L, Conforto Adriana, Magalhaes Pedro S C, Longo Alexandre L, Moro Carla H C, Appel Hamilton, Wille Paulo, Nagel Vivian, Venancio Vanessa, Garcia Adriana C, Mazin Suleimy Cristina, Goncalves Anderson R R
Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil.
Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil.
eNeurologicalSci. 2016 Apr 14;5:1-6. doi: 10.1016/j.ensci.2016.04.002. eCollection 2016 Dec.
Groundbreaking results concerning ischemic stroke (IS) hyperacute treatment worldwide were published in 2014 and 2015. We aimed to compare functional status after 3 months in patients treated with intra-arterial thrombectomy (IAT) and those treated with intravenous thrombolysis (IVT) alone in Joinville, Brazil. From the Joinville Stroke Registry, we extracted and compared all consecutive IVT patients treated with r-tPA within 4.5 h in the period 2009-2011 versus all consecutive IAT treated within 6 h with the Solitaire FR device plus IVT in the period 2012-2014. We registered 82 patients in the IVT group and 31 patients in the IAT group. At hospital admission, patients in the IAT group were significantly younger ( < 0.001), had a higher educational level ( = 0.001), had a slightly higher prevalence of atrial fibrillation ( = 0.057) and had more severe strokes measured by the NIH stroke scale ( = 0.011). After 90 days, 45% of patients in the IAT group and 27% in the IVT group were independent (0-1 points) according to the modified Rankin scale (adjusted odds ratio: 4.53; 95% CI: 1.22 to 16.75). Symptomatic hemorrhage was diagnosed in 10% of patients in both groups ( = 1.0). The 90-day case-fatality was 39% (32/82) in the IVT group and 26% (8/31) in the IAT group ( = 0.27). In this small cohort, a greater rate of functional independence was achieved in patients treated with IAT plus IVT, compared with patients treated with IVT lysis alone. Our "real-world" findings are consistent with results of controlled, randomized clinical trials.
2014年和2015年公布了全球范围内关于缺血性中风（IS）超急性期治疗的突破性成果。我们旨在比较巴西茹安维尔接受动脉内血栓切除术（IAT）治疗的患者与仅接受静脉溶栓（IVT）治疗的患者3个月后的功能状态。从茹安维尔中风登记处，我们提取并比较了2009 - 2011年期间在4.5小时内接受r - tPA治疗的所有连续IVT患者，与2012 - 2014年期间在6小时内接受Solitaire FR装置加IVT治疗的所有连续IAT患者。我们在IVT组登记了82例患者，在IAT组登记了31例患者。入院时，IAT组患者明显更年轻（<0.001），教育水平更高（=0.001），房颤患病率略高（=0.057），且根据美国国立卫生研究院中风量表测量的中风更严重（=0.011）。90天后，根据改良Rankin量表，IAT组45%的患者和IVT组27%的患者为独立状态（0 - 1分）（调整后的优势比：4.53；95%置信区间：1.22至16.75）。两组均有10%的患者被诊断为有症状性出血（=1.0）。IVT组90天病死率为39%（32/82），IAT组为26%（8/31）（=0.27）。在这个小队列中，与仅接受IVT溶栓治疗的患者相比，接受IAT加IVT治疗的患者实现功能独立的比例更高。我们的“真实世界”研究结果与对照随机临床试验的结果一致。
