静脉注射组织型纤溶酶原激活剂在伴有大血管闭塞的急性缺血性卒中中的作用

Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion.

作者信息

Ooi Yinn Cher, Miremadi Brian Behdad, Mukarram Faisal, Kaneko Naoki, Nour May, Colby Geoffrey, Jahan Reza, Tateshima Satoshi, Duckwiler Gary, Saver Jeffrey, Szeder Viktor

机构信息

Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, California, USA.

Department of Neurology, Harbor UCLA Medical Center, Torrance, California, USA.

出版信息

World Neurosurg. 2021 Apr;148:e321-e325. doi: 10.1016/j.wneu.2020.12.142. Epub 2021 Jan 11.

DOI:10.1016/j.wneu.2020.12.142

PMID:33444835

Abstract

OBJECTIVE

The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).

METHODS

We performed a retrospective analysis of prospectively collected data gathered during a 3-year period for all our patients with AIS and LVO. We analyzed the stroke outcomes and complications between patients who had received a combination of IVT and MT and those who had undergone MT only. Standardized selection criteria, including the uniform use of perfusion imaging, were used for selection for MT, irrespective of IVT administration.

RESULTS

Of the patients who had received IVT, 10% had had successful reperfusion found at initial angiography and did not require MT. A door-to-puncture time within 1 hour of presentation was achieved in 19% of both groups. IVT+MT was not associated with an increased incidence of intracranial hemorrhage (IVT+MT, 47.1%; MT, 49%). Of the 73 patients in IVT+MT group, 8 had developed access-site hematomas compared with 9 of the 95 patients in the MT group (28.6% vs. 26.5%; P = 0.85). The IVT+MT group had a lower proportion of patients with a modified Rankin scale score of 5-6 at 90 days compared with the MT group (36% vs. 56%; P = 0.024). Both groups showed statistically similar proportions of patients with a Thrombolysis in Cerebral Infarction scale score of ≥2c (IVT+MT, 50%; MT, 43%; P = 0.58). The IVT+MT group had a greater proportion of patients with Thrombolysis in Cerebral Infarction scale score of 2c (IVT+MT, 29.6%; MT, 16.8%; P = 0.068).

CONCLUSIONS

Administration of IVT before MT to patients with AIS with LVO resulted in reperfusion before MT in 10% of patients, reduced the incidence of mortality and severe disability at 90 days, did not affect the door-to-puncture time, and was associated with a similar incidence of systemic and intracranial hemorrhage compared with MT only.

摘要

目的

本研究的目的是确定静脉注射组织型纤溶酶原激活剂（IVT）在接受机械取栓术（MT）的急性缺血性卒中（AIS）伴大血管闭塞（LVO）患者中的安全性和有效性。

方法

我们对前瞻性收集的3年期间所有AIS和LVO患者的数据进行了回顾性分析。我们分析了接受IVT和MT联合治疗的患者与仅接受MT治疗的患者之间的卒中结局和并发症。无论是否给予IVT，均采用标准化的选择标准，包括统一使用灌注成像来选择MT治疗患者。

结果

在接受IVT治疗的患者中，10%在初次血管造影时实现了成功再灌注，无需进行MT。两组中19%的患者在就诊后1小时内达到了门到穿刺时间。IVT+MT组与颅内出血发生率增加无关（IVT+MT组为47.1%；MT组为49%）。在IVT+MT组的73例患者中，有8例发生了穿刺部位血肿，而MT组的95例患者中有9例发生（28.6%对26.5%；P = 0.85）。与MT组相比，IVT+MT组在90天时改良Rankin量表评分为5 - 6分的患者比例更低（36%对56%；P = 0.024）。两组中脑梗死溶栓量表评分≥2c的患者比例在统计学上相似（IVT+MT组为50%；MT组为43%；P = 0.58）。IVT+MT组中脑梗死溶栓量表评分为2c的患者比例更高（IVT+MT组为29.6%；MT组为l6.8%；P = 0.068）。