Guimarães Rocha Mariana, Carvalho Andreia, Rodrigues Marta, Cunha André, Figueiredo Sofia, Martins de Campos António, Gregório Tiago, Paredes Ludovina, Veloso Miguel, Barros Pedro, Castro Sérgio, Ribeiro Manuel, Costa Henrique
Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):627-631. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.002. Epub 2018 Nov 22.
Mechanical thrombectomy (MT) in combination with intravenous thrombolysis (IVT) is the standard of care for patients with acute ischemic stroke with anterior circulation large vessel occlusion. The particular benefit of IVT in these patients is unknown. We performed a retrospective analysis of patients submitted to MT at our center between January 2015 and June 2017. Functional outcome was prospectively assessed using modified Rankin scale (mRS) at 3 months. A total of 234 patients were enrolled, 152 (65%) in the combined treatment group and 82 (35%) in the direct MT group. Patients receiving combined treatment had a higher frequency of intracranial internal carotid artery occlusion (48 [31.6%] versus 16 [19.5%], P = .048) and significantly less strokes of cardioembolic etiology (72 [47.4%] versus 57 [69.5%], P = .01). Other baseline characteristics did not differ between the 2 groups. Good functional outcome at 3 months (mRS 0-2) was trending toward being higher in patients in the combined treatment group (98 [64.9%] versus 42 [52.5%], P = .066). Rates of symptomatic intracranial hemorrhage (5 [3.3%] versus 4 [4.9%], P = .723) and mortality (15 [9.9%] versus 14 [17.5%], P = .099) did not differ between groups. In multivariate logistic regression analysis, we did not find a statistically significant association between the use of IVT and any of the outcomes studied. Our results suggest that combined treatment carries similar effectiveness and safety than direct MT. Randomized controlled trials regarding this subject are warranted.
机械取栓（MT）联合静脉溶栓（IVT）是治疗急性缺血性脑卒中且伴有前循环大血管闭塞患者的标准治疗方法。IVT对这些患者的特殊益处尚不清楚。我们对2015年1月至2017年6月期间在本中心接受MT治疗的患者进行了回顾性分析。在3个月时使用改良Rankin量表（mRS）对功能结局进行前瞻性评估。共纳入234例患者，联合治疗组152例（65%），直接MT组82例（35%）。接受联合治疗的患者颅内颈内动脉闭塞的频率更高（48例[31.6%]对16例[19.5%]，P = 0.048），心源性栓塞病因的卒中明显更少（72例[47.4%]对57例[69.5%]，P = 0.01）。两组之间的其他基线特征无差异。联合治疗组患者3个月时良好的功能结局（mRS 0 - 2）有升高趋势（98例[64.9%]对42例[52.5%]，P = 0.066）。两组之间有症状性颅内出血率（5例[3.3%]对4例[4.9%]，P = 0.723）和死亡率（15例[9.9%]对14例[17.5%]，P = 0.099）无差异。在多因素逻辑回归分析中，我们未发现IVT的使用与所研究的任何结局之间存在统计学上的显著关联。我们的结果表明，联合治疗与直接MT具有相似的有效性和安全性。关于这一主题的随机对照试验是有必要的。
