Mai Duy Ton, Dao Viet Phuong, Nguyen Van Chi, Vu Dang Luu, Nguyen Tien Dung, Vuong Xuan Trung, Bui Quoc Viet, Phan Ha Quan, Pham Quang Tho, Le Hoang Kien, Tran Anh Tuan, Nguyen Quang Anh, Dang Phuc Duc, Nguyen Hoang, Phan Hoang Thi
Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam.
Department of Emergency and Intensive Care, Ha Noi Medical University, Ha Noi, Vietnam.
Front Neurol. 2021 Apr 9;12:653820. doi: 10.3389/fneur.2021.653820. eCollection 2021.
To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential benefits of treating low-dose alteplase, as opposed to standard-dose alteplase, prior to MTE among patients with LVO-AIS. The aim of the study was to compare outcomes of low- vs. standard-dose of bridging intravenous alteplase before MTE among LVO-AIS patients. We performed a retrospective analysis of LVO-AIS patients who were treated with either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in Northern Vietnam. Multivariable logistic regression models, accounting for potential confounding factors including comorbidities and clinical factors (e.g., stroke severity), were used to compare the outcomes between the two groups. Our primary outcome was functional independence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondary outcomes included any ICH incidence, early neurological improvement, recanalization rate, and 90-day mortality. We analyzed data of 107 patients receiving bridging therapy, including 73 with low-dose and 34 with standard-dose alteplase before MTE. There were no statistically significant differences between the two groups in functional independence at 90 days (adjusted OR 1.02, 95% CI 0.29-3.52) after accounting for potential confounding factors. Compared to the standard-dose group, patients with low-dose alteplase before MTE had similar rates of successful recanalization, early neurological improvement, 90-day mortality, and ICH complications. In the present study, patients with low-dose alteplase before MTE were found to achieve comparable clinical outcomes compared to those receiving standard-dose alteplase bridging with MTE. The findings suggest potential benefits of low-dose alteplase in bridging therapy for Asian populations, but this needs to be confirmed by further clinical trials.
迄今为止，在机械取栓（MTE）前进行静脉桥接溶栓的作用仍存在争议，但对于符合条件的患者仍被推荐使用。在亚洲，不同剂量的静脉用阿替普酶已被用于治疗大血管闭塞性急性缺血性卒中（LVO-AIS）患者，这主要是由于脑出血（ICH）风险和治疗费用的差异。对于LVO-AIS患者，在MTE前使用低剂量阿替普酶而非标准剂量阿替普酶治疗的潜在益处尚不确定。本研究的目的是比较LVO-AIS患者在MTE前接受低剂量与标准剂量静脉桥接阿替普酶的治疗结果。我们对在越南北部一家卒中中心接受MTE前使用0.6mg/kg或0.9mg/kg阿替普酶治疗的LVO-AIS患者进行了回顾性分析。使用多变量逻辑回归模型，考虑包括合并症和临床因素（如卒中严重程度）在内的潜在混杂因素，来比较两组的治疗结果。我们的主要结局是卒中后90天的功能独立性（改良Rankin量表评分；mRS≤2）。次要结局包括任何ICH发生率、早期神经功能改善、再通率和90天死亡率。我们分析了107例接受桥接治疗患者的数据，其中73例在MTE前接受低剂量阿替普酶治疗，34例接受标准剂量阿替普酶治疗。在考虑潜在混杂因素后，两组在90天的功能独立性方面无统计学显著差异（调整后的OR为1.02，95%CI为0.29-3.52）。与标准剂量组相比，MTE前接受低剂量阿替普酶治疗的患者成功再通率、早期神经功能改善、90天死亡率和ICH并发症发生率相似。在本研究中，发现MTE前接受低剂量阿替普酶治疗的患者与接受标准剂量阿替普酶桥接MTE治疗的患者临床结局相当。这些发现提示低剂量阿替普酶在亚洲人群桥接治疗中的潜在益处，但这需要通过进一步的临床试验来证实。
