Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian, China.
CNS Neurosci Ther. 2023 Aug;29(8):2377-2383. doi: 10.1111/cns.14227. Epub 2023 Apr 18.
Although intravenous thrombolysis (IVT) has not shown confirmative effects on the outcomes of patients receiving successful thrombectomy, it might influence the outcomes of a subset of these patients. This study aims to evaluate whether the effects of IVT depend on final reperfusion grade in patients with successful thrombectomy.
This is a single-center, retrospective analysis of patients with an acute anterior circulation large-vessel occlusion and a successful thrombectomy between January 2020 and June 2022. Final reperfusion grade was evaluated by the modified Thrombolysis in Cerebral Infarction (mTICI) score, which was dichotomized into incomplete (mTICI 2b) and complete (mTICI 3) reperfusion. The primary outcome was functional independence (90-day modified Rankin Scale score 0-2). Safety outcomes were 24-h symptomatic intracranial hemorrhage and 90-day all-cause mortality. Multivariable logistic regression analyses were used to assess the interactions between IVT treatment and final reperfusion grade on outcomes.
When comparing all 167 patients enrolled in the study, IVT did not influence the extent of functional independence (adjusted OR: 1.38; 95% CI: 0.65-2.95; p = 0.397). The effect of IVT on functional independence depended on final reperfusion grade (p = 0.016). IVT benefited patients with incomplete reperfusion (adjusted OR: 3.70; 95% CI 1.21-11.30; p = 0.022), but not those with complete reperfusion (adjusted OR: 0.48, 95% CI: 0.14-1.59; p = 0.229). IVT was not associated with 24-h symptomatic intracerebral hemorrhage (p = 0.190) or 90-day all-cause mortality (p = 0.545).
The effect of IVT on functional independence depended on final reperfusion grade in patients with successful thrombectomy. IVT appeared to benefit patients with incomplete reperfusion, but not those with complete reperfusion. Because reperfusion grade cannot be determined prior to endovascular treatment, this study argues against withholding IVT in IVT-eligible patients.
尽管静脉溶栓（IVT）并未对接受成功取栓治疗的患者的结局产生明确影响，但它可能会影响到其中一部分患者的结局。本研究旨在评估 IVT 的效果是否取决于成功取栓患者的最终再灌注分级。
这是一项单中心、回顾性分析，纳入了 2020 年 1 月至 2022 年 6 月期间接受急性前循环大血管闭塞和成功取栓治疗的患者。最终再灌注分级采用改良脑梗死溶栓（mTICI）评分评估，分为不完全（mTICI 2b）和完全（mTICI 3）再灌注。主要结局为功能独立性（90 天改良 Rankin 量表评分 0-2 分）。安全性结局为 24 小时症状性颅内出血和 90 天全因死亡率。多变量逻辑回归分析用于评估 IVT 治疗与最终再灌注分级对结局的交互作用。
在比较研究中纳入的 167 例患者时，IVT 并未影响功能独立性的程度（调整后的 OR：1.38；95%CI：0.65-2.95；p=0.397）。IVT 对功能独立性的影响取决于最终再灌注分级（p=0.016）。IVT 使不完全再灌注患者获益（调整后的 OR：3.70；95%CI：1.21-11.30；p=0.022），但对完全再灌注患者无获益（调整后的 OR：0.48，95%CI：0.14-1.59；p=0.229）。IVT 与 24 小时症状性颅内出血（p=0.190）或 90 天全因死亡率（p=0.545）无关。
在成功取栓的患者中，IVT 对功能独立性的影响取决于最终再灌注分级。IVT 似乎使不完全再灌注患者获益，但对完全再灌注患者无益。由于在血管内治疗前无法确定再灌注分级，因此本研究反对在 IVT 适应证患者中不使用 IVT。
