Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu, China; Depatment of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu, China.
Depatment of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu, China; Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, China.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105473. doi: 10.1016/j.jstrokecerebrovasdis.2020.105473. Epub 2020 Dec 1.
Current evidence does not agree on the merits of direct and bridging thrombectomy. This study aimed to compare the safety and efficacy of direct thrombectomy (DT) and bridging thrombectomy (BT) in treating patients with acute ischaemic stroke due to carotid T occlusion.
Patients with stroke due to carotid T occlusion who were treated with DT or BT were retrospectively collected from four advanced stroke centres. Baseline characteristics and clinical outcomes were compared between the groups. Successful recanalization was defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2b or 3. A favourable outcome was defined by a modified Rankin Scale (mRS) score of 0-2 at 90 days after stroke onset. Multivariable analysis was performed to control for potential confounders.
Of the 111 enrolled patients, 57 (51.4%) patients were treated with DT, and 54 (48.6%) were treated with BT. Patients treated with DT had a shorter imaging to puncture (ITP) time (53 min versus 92 min, P<0.001) and symptom onset to puncture (OTP) time (198 min versus 218 min, P=0.045) than patients treated with BT. No significant difference was detected concerning the rate of successful recanalization (80.7% versus 77.8%, P=0.704) or a favourable outcome between patients treated with DT and BT (35.1% versus 33.3%, P=0.846). Patients treated with DT had a lower intracranial haemorrhage (ICH) rate (40.4% versus 59.3%, P=0.046), but the difference was not significant for symptomatic ICH (sICH, 12.3% versus 16.7%, P=0.511) or asymptomatic ICH (aICH, 28.1% versus 42.6%, P=0.109). After adjusting for potential confounding factors, the ratio of favorable prognosis, successful reperfusion, sICH and mortality did not differ between the two groups. However, there was a higher rate of ICH (OR=2.492, 95% CI 1.005 to 6.180, p=0.049) in the BT group as compared with the DT group.
DT seems equivalent to BT in treating stroke due to carotid T occlusion in favorable outcome, successful recanalization, 90-day morality and sICH. However, BT may increase the incidence of ICH in this specific type stroke.
目前的证据尚不能确定直接取栓和桥接取栓的优劣。本研究旨在比较直接取栓（DT）和桥接取栓（BT）治疗颈内动脉 T 段闭塞所致急性缺血性脑卒中患者的安全性和疗效。
从 4 家高级卒中中心回顾性收集因颈内动脉 T 段闭塞导致卒中且接受 DT 或 BT 治疗的患者。比较两组患者的基线特征和临床结局。采用改良脑梗死溶栓（mTICI）评分 2b 或 3 级定义为成功再通。采用改良 Rankin 量表（mRS）评分 0-2 分定义为发病 90 d 时预后良好。采用多变量分析控制潜在混杂因素。
共纳入 111 例患者，57 例（51.4%）接受 DT 治疗，54 例（48.6%）接受 BT 治疗。与 BT 组相比，DT 组的影像学至穿刺时间（53 min 比 92 min，P<0.001）和症状发作至穿刺时间（198 min 比 218 min，P=0.045）更短。两组患者的再通率（80.7%比 77.8%，P=0.704）或预后良好率（35.1%比 33.3%，P=0.846）差异无统计学意义。DT 组颅内出血（ICH）发生率较低（40.4%比 59.3%，P=0.046），但症状性 ICH（sICH，12.3%比 16.7%，P=0.511）和无症状性 ICH（aICH，28.1%比 42.6%，P=0.109）发生率差异无统计学意义。调整潜在混杂因素后，两组患者的预后良好、再通成功、sICH 和死亡率的比值无差异。然而，BT 组 ICH 发生率高于 DT 组（OR=2.492，95%CI 1.005 至 6.180，p=0.049）。
DT 治疗颈内动脉 T 段闭塞性卒中的疗效与 BT 相当，在预后良好、再通成功、90 天死亡率和 sICH 方面无差异。然而，BT 可能会增加此类特定类型卒中的 ICH 发生率。
