Vascular and Interventional Radiology Center, Tampere University Hospital, Tampere, Finland.
Medical Imaging Center, Tampere University Hospital, PL2000, 33521, Tampere, Finland.
Cardiovasc Intervent Radiol. 2021 Apr;44(4):580-586. doi: 10.1007/s00270-020-02727-8. Epub 2020 Dec 22.
Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO.
We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis.
Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0-1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients.
MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.
机械血栓切除术（MT）是急性大血管闭塞（LVO）患者的一线治疗方法。静脉溶栓（IVT）在 MT 之前的疗效存在争议。本研究的目的是评估无 IVT 的 MT 在无 IVT 禁忌且直接进入三级卒中中心的急性前循环 LVO 患者中的疗效。
我们收集了在一家高容量卒中中心接受 MT 的 106 例急性卒中患者的数据。纳入符合 IVT 适应证且直接进入我院并随后接受 MT 的前循环 LVO 患者。我们记录了基线临床、实验室、程序和影像学变量以及技术、影像学和临床结局。采用单变量检验、二项和有序逻辑回归分析，分析 IVT 对 3 个月临床结局（mRS）的影响。
106 例患者中有 58 例接受了 IVT+MT。与仅接受 MT 的患者相比，mRS 移位分析中 IVT+MT 患者的临床结局较差的可能性高 2.6 倍（p=0.01），而 3 个月临床结局（mRS 0-1）良好的可能性高 3 倍（p=0.009）。两组之间在过程时间、mTICI 或出血性并发症数量方面无显著差异。仅接受 MT 的患者中观察到远端栓塞较少和器械通过次数较多的趋势。
无 IVT 的 MT 与急性前循环 LVO 患者的整体 3 个月临床结局改善相关。
