Tajima Yosuke, Hayasaka Michihiro, Ebihara Kouichi, Kubota Masaaki, Matsuda Tatsuma, Nishino Wataru, Suda Sumio
Department of Neurosurgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu 4-9-1 292-8535, Japan.
Department of Neurosurgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu 4-9-1 292-8535, Japan.
J Vasc Interv Radiol. 2019 Feb;30(2):134-140. doi: 10.1016/j.jvir.2018.11.005.
To determine whether thrombolysis with a lower dose of intravenous recombinant tissue plasminogen activator before mechanical thrombectomy is beneficial for functional outcomes compared with mechanical thrombectomy alone.
Data for 100 Japanese patients who underwent mechanical thrombectomy between July 2014 and November 2017 were retrospectively reviewed. These patients were divided into groups according to whether they received intravenous thrombolysis before mechanical thrombectomy, and outcomes were compared. Favorable outcome was defined as a modified Rankin scale score ≤ 2 at 3 months after treatment.
Thirty-four patients for the thrombolysis group and 66 patients for the thrombectomy-only group were identified. The thrombolysis and nonthrombolysis groups did not differ significantly in baseline characteristics (mean age, 74.3 y vs 75.7 y [P = .485]; mean preoperative National Institute Health Stroke Scale score, 19.8 vs 19.6 [P = .825]). There were no significant differences in the times required for, or the rates of, successful recanalization. However, the thrombolysis group had a higher rate of complete recanalization (67.6% vs 43.9%; P = .041). Postoperative symptomatic intracranial hemorrhage was not significantly different between groups. Favorable outcomes were observed in 73.5% of patients in the thrombolysis group and 51.5% in the nonthrombolysis group (P = .028).
This single-center retrospective study shows that lower-dose intravenous thrombolysis improves the outcomes of mechanical thrombectomy for Japanese patients with acute anterior-circulation stroke treated within 4.5 hours of onset.
确定在机械取栓术前使用较低剂量静脉注射重组组织型纤溶酶原激活剂进行溶栓与单纯机械取栓相比，是否对功能结局有益。
回顾性分析2014年7月至2017年11月期间接受机械取栓的100例日本患者的数据。根据患者在机械取栓术前是否接受静脉溶栓将其分组，并比较结局。良好结局定义为治疗后3个月改良Rankin量表评分≤2分。
确定了溶栓组34例患者和单纯取栓组66例患者。溶栓组和未溶栓组在基线特征方面无显著差异（平均年龄，74.3岁对75.7岁[P = 0.485]；术前平均美国国立卫生研究院卒中量表评分，19.8对19.6[P = 0.825]）。成功再通所需时间或再通率无显著差异。然而，溶栓组的完全再通率更高（67.6%对43.9%；P = 0.041）。两组术后症状性颅内出血无显著差异。溶栓组73.5%的患者和未溶栓组51.5%的患者观察到良好结局（P = 0.028）。
这项单中心回顾性研究表明，较低剂量静脉溶栓可改善发病4.5小时内接受治疗的日本急性前循环卒中患者机械取栓的结局。
