Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Department of Neurology, Allegheny Health Network, Pittsburgh, PA, United States.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105732. doi: 10.1016/j.jstrokecerebrovasdis.2021.105732. Epub 2021 Apr 14.
Although intravenous thrombolysis (IVT) is recommended among acute ischemic stroke (AIS) patients secondary to large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT), time delays with bridging therapy (IVT prior to MT) and its potential benefit remains unclear. We compared the time delays and clinical outcomes among AIS SECONDARY TO LVO patients treated with bridging therapy or direct MT (dMT) at a comprehensive stroke center (CSC).
We performed a retrospective analysis of prospectively collected data of AIS secondary to LVO patients admitted between 2012 and 2017 at a large volume CSC. AIS secondary to LVO patients arriving directly from field to CSC within 4.5 h were included. Demographic characteristics, clinical and radiological data, treatment and procedural information were extracted and analyzed.
Among 777 AIS secondary to LVO patients treated with MT, 237 patients (156 dMT, 81 bridging therapy) were included. Mean age was 70.3 year-old, median NIHSS score was 18, and door-to-needle time was 40 min (IQR 31-56 min). The median door-to-puncture (DTP) time was 22 min longer in bridging therapy group in comparison to dMT group, 74 vs 52 min (p<0.001). Additionally, no difference was observed between the groups for successful recanalization or functional independence.
At a large volume CSC, bridging therapy (vs. dMT) was observed to have a longer DTP time without any difference in successful recanalization or clinical outcomes.
尽管对于接受机械取栓（MT）治疗的大血管闭塞（LVO）急性缺血性脑卒中（AIS）患者，建议采用静脉溶栓（IVT）治疗，但桥接治疗（MT 前进行 IVT）的时间延迟及其潜在获益仍不明确。我们比较了在综合性卒中中心（CSC）接受桥接治疗或直接 MT（dMT）治疗的 LVO 继发 AIS 患者的时间延迟和临床结局。
我们对一家大容量 CSC 2012 年至 2017 年期间收治的 LVO 继发 AIS 患者前瞻性采集数据进行了回顾性分析。将直接从现场转运至 CSC 且在 4.5 小时内到达的 AIS 继发 LVO 患者纳入研究。提取并分析了患者的人口统计学特征、临床和影像学数据、治疗及手术信息。
在 777 例接受 MT 治疗的 LVO 继发 AIS 患者中，有 237 例（156 例接受 dMT，81 例接受桥接治疗）患者被纳入研究。患者的平均年龄为 70.3 岁，NIHSS 中位数为 18 分，门到针时间为 40 分钟（IQR 31-56 分钟）。与 dMT 组相比，桥接治疗组的门到穿剌时间中位数长 22 分钟，分别为 74 分钟和 52 分钟（p<0.001）。此外，两组之间的再通成功率或功能独立性均无差异。
在大容量 CSC，与 dMT 相比，桥接治疗（vs. dMT）的 DTP 时间更长，但再通成功率或临床结局并无差异。
