静脉溶栓联合血管内血栓切除术与直接血管内血栓切除术治疗前循环急性缺血性卒中：临床及梗死体积结果
Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.
作者信息
Gamba Massimo, Gilberti Nicola, Premi Enrico, Costa Angelo, Frigerio Michele, Mardighian Dikran, Vergani Veronica, Spezi Raffaella, Delrio Ilenia, Morotti Andrea, Poli Loris, De Giuli Valeria, Caria Filomena, Pezzini Alessandro, Gasparotti Roberto, Padovani Alessandro, Magoni Mauro
机构信息
Stroke Unit, Neurologia Vascolare, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia 25123, Brescia, Italy.
Servizio di Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
出版信息
BMC Neurol. 2019 May 29;19(1):103. doi: 10.1186/s12883-019-1341-3.
BACKGROUND
endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients remains unclear. The present study aims to investigate whether IVT followed by ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS with LVO.
METHODS
we achieved a single center retrospective study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. Functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up brain CT scan infarct volume (EFIV) (for recanalized patients only), symptomatic intracerebral hemorrhage (sICH) and 3-month mortality were the outcomes of interests. Independent predictors of the outcomes were explored with multivariable logistic regression.
RESULTS
145 subjects were included in the study, of whom 70 underwent direct ET and 75 were treated with CoT. Functional independence at 3-months was more frequent in CoT subjects compared to patients who received direct ET (mRS score 0-1: 48.5% vs 18.6%; P < 0.001. mRS score 0-2: 67.1% vs 37.3%; P < 0.001); CoT patients had also higher first-pass success rate (62.7% vs 38.6%, P < 0.05), higher recanalization rate (84.3% vs 65.3%; P = 0.009) and, in recanalized subjects, smaller EFIV (16.4 ml vs 62.3 ml; P = 0.003). Mortality and intracranial bleeding did not differ between the two groups. In multivariable regression analysis, low baseline NIHSS score (P < 0.05), vessel recanalization (P = 0.05) and CoT (P = 0.03) were independent predictors of favorable outcome at three months.
CONCLUSIONS
CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.
背景
血管内治疗（ET）是治疗由大血管闭塞（LVO）引起的前循环急性缺血性卒中（AIS）的标准治疗方法。辅助静脉溶栓（IVT）在这些患者中的作用仍不明确。本研究旨在探讨对于前循环LVO所致AIS患者，先进行IVT再行ET（联合治疗，CoT）是否比直接ET能带来更多益处。
方法
我们对2014年1月至2017年1月间转诊至我院并接受ET治疗的前循环LVO所致AIS患者进行了单中心回顾性研究。功能恢复情况（3个月随访时的改良Rankin量表评分）、再通率（脑梗死溶栓[TICI]评分）及时间、早期随访脑CT扫描梗死体积（仅针对再通患者）、症状性颅内出血（sICH）和3个月死亡率为感兴趣的结局指标。通过多变量逻辑回归探索结局指标的独立预测因素。
结果
145名受试者纳入研究，其中70例接受直接ET治疗，75例接受CoT治疗。与接受直接ET治疗的患者相比，CoT治疗的患者在3个月时功能独立更为常见（改良Rankin量表评分0 - 1：48.5%对18.6%；P < 0.001。改良Rankin量表评分0 - 2：67.1%对37.3%；P < 0.001）；CoT治疗的患者首次通过成功率也更高（62.7%对38.6%，P < 0.05），再通率更高（84.3%对65.3%；P = 0.009），并且在再通的受试者中，梗死体积更小（16.4 ml对62.3 ml；P = 0.003）。两组的死亡率和颅内出血情况无差异。在多变量回归分析中，低基线美国国立卫生研究院卒中量表（NIHSS）评分（P < 0.05）、血管再通（P = 0.05）和CoT治疗（P = 0.03）是3个月时良好结局的独立预测因素。
结论
对于前循环LVO所致AIS，联合治疗似乎比单纯ET更有效，且安全性相似。
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