Department of Clinical Neurosciences (J.M.O., N.S., M.A.A., B.K.M., A.M.D., M.G., M.D.H.), University of Calgary, Canada.
Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.).
Stroke. 2021 Jan;52(1):304-307. doi: 10.1161/STROKEAHA.120.031591. Epub 2020 Nov 20.
Quantitating the effect of intravenous alteplase on the technical outcome of early recanalization of large vessel occlusions aids understanding. We report the prevalence of early recanalization in patients with stroke because of large vessel occlusion treated with and without intravenous alteplase and endovascular thrombectomy, and its association with clinical outcome.
Patients with acute ischemic stroke with large vessel occlusion from the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times Trial) were included in this post hoc analysis. Outcomes of interest were the prevalence of early recanalization (1) and good outcome (2), defined as modified Rankin Scale score of 0 to 2 at 90 days.
Among 147 patients who did not receive endovascular thrombectomy, early recanalization occurred in 4/30 (13.3%) patients without and 48/117 (41.0%) patients with intravenous alteplase (adjusted risk ratios, 3.2 [95% CI, 1.2-8.1]). Good outcome was achieved by 34/116 (29.3%) of patients who received intravenous alteplase versus 10/29 (34.5%) who did not receive alteplase (adjusted risk ratios, 1.0 [95% CI, 0.6-1.5) and by 20/52 (38.5%) patients with versus 24/93 (25.8%) without early recanalization (adjusted risk ratios, 1.9 [95% CI, 1.2-2.9]).
Early recanalization was confirmed as a strong predictor of good outcome in patients who did not undergo endovascular thrombectomy and was improved with intravenous alteplase, yet a majority of patients (59.0%) did not achieve early reperfusion. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01778335.
定量评估静脉内使用阿替普酶对大血管闭塞早期再通的效果有助于理解。我们报告了因大血管闭塞而接受静脉内阿替普酶和血管内血栓切除术治疗的患者的早期再通率及其与临床结局的关系。
本研究纳入了 ESCAPE 试验（小核心和前循环近端闭塞的血管内治疗与强调最小化 CT 至再通时间试验）的急性缺血性卒中伴大血管闭塞的患者。本研究的观察终点为早期再通率（1）和良好结局（2）。
在 147 例未接受血管内血栓切除术的患者中，未接受静脉内阿替普酶治疗的患者中有 4/30（13.3%）患者发生早期再通，而接受静脉内阿替普酶治疗的患者中有 48/117（41.0%）患者发生早期再通（校正风险比为 3.2[95%可信区间为 1.2-8.1]）。接受静脉内阿替普酶治疗的患者中，293 例中有 34 例（29.3%）患者获得良好结局，而未接受阿替普酶治疗的患者中，116 例中有 10 例（34.5%）患者获得良好结局（校正风险比为 1.0[95%可信区间为 0.6-1.5]）；接受静脉内阿替普酶治疗的患者中，52 例有早期再通的患者中有 20 例（38.5%）获得良好结局，而未接受静脉内阿替普酶治疗的患者中，93 例无早期再通的患者中有 24 例（25.8%）获得良好结局（校正风险比为 1.9[95%可信区间为 1.2-2.9]）。
早期再通被证实是未接受血管内血栓切除术治疗的患者获得良好结局的有力预测因素，且静脉内使用阿替普酶可改善早期再通率，但大多数患者（59.0%）仍未实现早期再灌注。
