Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis, Tennesseee, United States.
J Neurointerv Surg. 2019 Nov;11(11):1073-1079. doi: 10.1136/neurintsurg-2019-014746. Epub 2019 May 14.
We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center.
Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented.
A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8% vs 62.9%; p=0.023) and 3-month functional independence (modified Rankin Scale score 0-2;51.6% vs 38.2%; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33-70) vs 70 (IQR 44-98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1-1) vs 2 (IQR 1-2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98% vs 77%; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95% CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient -20.39; 95% CI -27.56 to -13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95% CI 4.46 to 48.00; p<0.001).
IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.
我们旨在评估在高容量的三级卒中中心中，对接受机械血栓切除术（MT）治疗的紧急大血管闭塞（ELVO）患者进行静脉溶栓（IVT）预处理对成功再灌注（SR）的速度和速度的影响。
评估了接受 MT 治疗的 ELVO 连续患者。比较了联合 IVT 和 MT（IVT+MT）治疗的患者与直接 MT（dMT）治疗的患者之间的结果。还记录了从腹股沟穿刺到开始再灌注（GPTBRT）之间的时间以及达到 SR 所需的设备通过次数。
共有 287 名和 132 名患者分别接受了 IVT+MT 和 dMT 治疗。IVT+MT 组 SR（73.8%比 62.9%；p=0.023）和 3 个月功能独立性（改良 Rankin 量表评分 0-2；51.6%比 38.2%；p=0.008）的比例更高。IVT+MT 组的中位 GPTBRT 更短（48（IQR 33-70）比 70（IQR 44-98）分钟；p<0.001）。在达到 SR 的患者中（n=292），IVT+MT 亚组所需设备通过的中位数更低（1（IQR 1-1）比 2（IQR 1-2）；p<0.001），而需要≤2 次设备通过的患者比例更高（98%比 77%；p<0.001）。IVT+MT 与更高的 SR 几率独立相关（OR 1.64；95%CI 1.03 至 2.61；p=0.036）和 GPTBRT 更短（多变量分析调整潜在混杂因素后，标准化线性回归系数-20.39；95%CI-27.56 至-13.22；p<0.001）。在达到 SR 的患者中，IVT+MT 与需要≤2 次设备通过的可能性更高独立相关（OR 14.63；95%CI 4.46 至 48.00；p<0.001）。
在接受 MT 治疗的 ELVO 患者中，IVT 预处理似乎通过减少设备通过次数，增加了 SR 的速度，并缩短了血管内手术的持续时间。
