Department of Neurology, University Hospital Heidelberg, Germany.
Department of Neuroradiology, University Hospital Heidelberg, Germany.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104868. doi: 10.1016/j.jstrokecerebrovasdis.2020.104868. Epub 2020 May 13.
Safety and efficacy of endovascular thrombectomy (EVT) in patients with mild stroke syndromes is unclear, especially in distal vessel occlusions.
We analysed in our stroke database (HeiReKa) between 2002 and April 2019 safety and efficacy of EVT compared to intravenous thrombolysis (IVT) in patients with occlusions distal to the M1 segment of the middle cerebral artery and the top of the basilar artery who presented with a National Institute of Health Stroke Scale (NIHSS) below 6. Excellent (good) outcome was defined as modified rankin scale (mRS) 0-1 (0-2) or return to baseline mRS (good) after 3 months. Safety endpoints were mortality after 3 months and intracranial hemorrhage according to the Heidelberg Bleeding Classification (HBC).
Of 4167 patients 94 met the inclusion criteria. Sixty-four patients were allocated to the IVT group and 30 to the EVT group of which 15 also received IVT; three patients (4.6%) in the IVT group received rescue EVT. Baseline characteristics did not differ but more M2 occlusions were found in the EVT group (93.3% vs. 64.1%, p = 0.02). Intracranial bleeding occurred more often in EVT patients (HBC class 2: 13.3% vs. 1.6%, p = 0.01). Excellent and good outcome were not significantly different (75% vs. 70%, p = 0.65 and 87.5% vs. 73.3%, p = 0.14). Mortality was significantly lower in IVT patients (1.6% vs. 13.3%, p = 0.04).
Rates of excellent and good outcome after IVT or EVT were almost similar, but safety parameters were increased after EVT. EVT may be considered in selected patients after careful risk/benefit analysis.
血管内血栓切除术（EVT）治疗轻度卒中综合征患者的安全性和疗效尚不清楚，尤其是在远端血管闭塞的情况下。
我们分析了 2002 年至 2019 年 4 月期间我们的卒中数据库（HeiReKa）中，与接受静脉溶栓治疗（IVT）的患者相比，接受 EVT 治疗的大脑中动脉 M1 段远端和基底动脉顶部闭塞且 NIHSS 评分低于 6 分的患者的安全性和疗效。良好的预后定义为改良 Rankin 量表（mRS）0-1（0-2）或 3 个月后恢复基线 mRS（良好）。安全性终点为 3 个月后的死亡率和根据海德堡出血分级（HBC）的颅内出血。
在 4167 例患者中，有 94 例符合纳入标准。64 例患者被分配到 IVT 组，30 例患者被分配到 EVT 组，其中 15 例也接受了 IVT；3 例（4.6%）IVT 组患者接受了挽救性 EVT。基线特征无差异，但 EVT 组的 M2 闭塞更多（93.3%比 64.1%，p=0.02）。EVT 组颅内出血更常见（HBC 2 级：13.3%比 1.6%，p=0.01）。良好预后的比例在 IVT 组和 EVT 组之间无显著差异（75%比 70%，p=0.65 和 87.5%比 73.3%，p=0.14）。IVT 组死亡率明显较低（1.6%比 13.3%，p=0.04）。
IVT 或 EVT 后良好预后的发生率几乎相似，但 EVT 后安全性参数增加。在仔细进行风险/获益分析后，EVT 可考虑用于某些患者。
