Viannay Louis, Haesebaert Julie, Florin Fannie, Riva Roberto, Mechtouff Laura, Gory Benjamin, Ong Elodie, Labeyrie Paul-Emile, Derex Laurent, Hermier Marc, Chamard Leila, Berner Lise-Prune, Ameli Roxana, Berthezène Yves, Turjman Francis, Nighoghossian Norbert, Cho Tae-Hee
Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
Health Information Department, HESPER EA7425, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
Front Neurol. 2018 Aug 28;9:722. doi: 10.3389/fneur.2018.00722. eCollection 2018.
Randomized trials (RT) have recently validated the superiority of thrombectomy over standard medical care, including intravenous thrombolysis (IVT). However, data on their impact on routine clinical care remains scarce. Using a prospective observational registry, we assessed: (1) the clinical and radiological characteristics of all consecutive patients treated with thrombectomy; (2) the outcome of all patients with M1 occlusion (treated with thrombectomy or IVT alone). Two periods were compared: before (2013-2014) and after (2015-2016) the publication of RT. Endovascular procedures significantly increased between the two periods ( = 82 vs. 314, < 0.0001). In 2015-2016, patients were older (median [IQR]: 69 [57-80]; vs. 66 [53-74]; = 0.008), had shorter door-to-clot times (69 [47-95]; vs. 110 [83-155]; < 0.0001) resulting in a trend toward shorter delay from symptom onset to reperfusion (232 [185-300]; vs. 250 [200-339]; = 0.1), with higher rates of reperfusion (71 vs. 48%; = 0.0001). Conversely, no significant differences in baseline NIHSS scores, ASPECTS, delay to IVT or intracranial hemorrhage were found. In 2015-2016, patients with M1 occlusion were treated with thrombectomy more often than in 2013-2014 (87 vs. 32%, respectively; < 0.0001), with a significant improvement in clinical outcome (shift analysis, lower modified Rankin scale scores: OR = 1.68; 95% CI: 1.10-2.57; = 0.017). Following the publication of RT, thrombectomy was rapidly implemented with significant improvements in intrahospital delay and reperfusion rates. Treatment with thrombectomy increased with better clinical outcomes in patients with M1 occlusion.
随机试验（RT）最近证实了血栓切除术相对于包括静脉溶栓（IVT）在内的标准医疗护理的优越性。然而，关于其对常规临床护理影响的数据仍然很少。我们使用前瞻性观察登记系统进行了评估：（1）所有接受血栓切除术的连续患者的临床和影像学特征；（2）所有M1段闭塞患者（单独接受血栓切除术或IVT治疗）的结局。比较了两个时期：RT发表之前（2013 - 2014年）和之后（2015 - 2016年）。两个时期之间血管内手术显著增加（分别为82例与314例，P < 0.0001）。在2015 - 2016年，患者年龄更大（中位数[四分位间距]：69岁[57 - 80岁]；与66岁[53 - 74岁]相比；P = 0.008），从入院到血栓形成的时间更短（69分钟[47 - 95分钟]；与110分钟[83 - 155分钟]相比；P < 0.0001），导致从症状发作到再灌注的延迟有缩短趋势（232分钟[185 - 300分钟]；与250分钟[200 - 339分钟]相比；P = 0.1），再灌注率更高（71%对48%；P = 0.0001）。相反，在基线美国国立卫生研究院卒中量表（NIHSS）评分、脑缺血半暗带评分（ASPECTS）、静脉溶栓延迟或颅内出血方面未发现显著差异。在2015 - 2016年，M1段闭塞患者接受血栓切除术的比例比2013 - 2014年更高（分别为87%和32%；P < 0.0001），临床结局有显著改善（移位分析，改良Rankin量表评分更低：比值比 = 1.68；95%置信区间：1.10 - 2.57；P = 0.017）。RT发表后，血栓切除术迅速得到应用，医院内延迟和再灌注率有显著改善。M1段闭塞患者接受血栓切除术治疗增加，临床结局更好。
