From the Department of Neurology (C.C., C.R.L., N.J.S., F.M., L.L.), John Hunter Hospital; University of Newcastle (C.C., C.R.L., N.J.S., F.M., L.L.); Hunter Medical Research Institute (C.C., C.R.L., N.J.S., F.M., L.L.), Newcastle; Department of Neurology (M.W.P., A.B.), Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Australia; Department of Neurology (X.C., Q.D.), Huashan Hospital, Fudan University, Shanghai; Department of Neurology (M.L.), Second Affiliated Hospital of Zhejiang University, Hangzhou, China; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; and Division of Neurology (K.B.), Department of Medicine, University of Alberta, Edmonton, Canada.
Neurology. 2019 Jul 16;93(3):e283-e292. doi: 10.1212/WNL.0000000000007768. Epub 2019 Jun 17.
To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO).
EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes.
From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0-1 odds ratio 0.01, < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals ( = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0-1 odds ratio 1.61, < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, = 0.008).
From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
评估在大血管闭塞（LVO）患者中，静脉溶栓（IVT-R）后完全再灌注是否会产生与血管内血栓切除术（EVT-R）后完全再灌注相似的临床结局。
从国际卒中灌注成像登记处（INSPIRE）中，根据年龄、临床严重程度、闭塞部位和基线灌注损伤体积，对 EVT-R 患者进行匹配，选择与 IVT-R 患者相匹配的患者。仅纳入在随访影像学上显示完全再灌注的患者。比较在基线缺血核心和半影体积逐渐增加的五分位数中，EVT-R 与 IVT-R 患者在第 90 天改良 Rankin 量表（mRS）上的优秀临床结局率。
从 INSPIRE 中，共有 141 名 EVT-R 患者和 141 名符合条件的对照者（IVT-R）。在基线核心体积＜30ml 的患者中，EVT-R 与 IVT-R 相比，第 90 天获得良好结局的可能性较低（第 90 天 mRS 0-1 比值 0.01，＜0.001）。基线核心体积＜30ml 的患者主要为远端 M1 或 M2 闭塞，且侧支循环良好（=0.01）。在基线缺血核心体积＞30ml 的患者（颈内动脉和主要为近端 M1 闭塞）中，EVT-R 增加了患者获得良好临床结局的可能性（第 90 天 mRS 0-1 比值 1.61，＜0.001），且 IVT-R 组的症状性颅内出血发生率较高（20% vs EVT-R 组的 3%，=0.008）。
从这个观察性队列中，与单独接受 IVT-R 相比，基线缺血核心更大、近端 LVO、侧支循环较差的 LVO 患者，接受 EVT-R 治疗明显获益。然而，对于远端 LVO 患者，由于其缺血核心较小，侧支循环较好，与单独接受 IVT-R 相比，EVT-R 与获得良好结局的可能性较低相关。
