Neurology Department, Hôpital Saint-Joseph, Paris, France.
Service de Recherche Clinique, Hôpital Fondation A. de Rothschild, Paris, France.
Ann Neurol. 2023 Sep;94(3):596-604. doi: 10.1002/ana.26720. Epub 2023 Jun 26.
Two randomized trials demonstrated the benefit of endovascular therapy (EVT) in patients suffering from a stroke due to a basilar artery occlusion (BAO). However, intravenous thrombolytic (IVT) use before EVT was low in these trials, questioning the added value of this treatment in this setting. We sought to investigate the efficacy and safety of EVT alone compared to IVT + EVT in stroke patients with a BAO.
We analyzed data from the Endovascular Treatment in Ischemic Stroke registry, a prospective, observational, multicenter study of acute ischemic stroke patients treated with EVT in 21 centers in France between 1 January 2015 and 31 December 2021. We included patients with BAO and/or intracranial vertebral artery occlusion and compared patients treated with EVT alone versus IVT + EVT after propensity score (PS) matching. Variables selected for the PS were pre-stroke mRS, dyslipidemia, diabetes, anticoagulation, admission mode, baseline NIHSS and ASPECTS, type of anesthesia, and time from symptom onset to puncture. Efficacy outcomes were good functional outcome (modified Rankin Scale [mRS] 0-3) and functional independence (mRS 0-2) at 90 days. Safety outcomes were symptomatic intracranial hemorrhages and all-cause mortality at 90 days.
Among 385 patients, 243 (134 EVT alone and 109 IVT + EVT) were included after PS matching. There was no difference between EVT alone and IVT + EVT regarding good functional outcome (adjusted odd ratio [aOR] labeling = 1.27, 95% confidence interval [CI], 0.68-2.37, p = 0.45) and functional independence (aOR = 1.50, 95% CI, 0.79-2.85, p = 0.21). Symptomatic intracranial hemorrhage and all-cause mortality were also similar between the two groups (aOR = 0.42, 95% CI, 0.10-1.79, p = 0.24 and aOR = 0.56, 95% CI, 0.29-1.10, p = 0.09, respectively).
In this PS matching analysis, EVT alone seemed to lead to similar neurological recovery than IVT + EVT, with comparable safety profile. However, given our sample size and the observational nature of this study, further studies are needed to confirm these findings. ANN NEUROL 2023;94:596-604.
两项随机试验证明了血管内治疗（EVT）对基底动脉闭塞（BAO）引起的中风患者的益处。然而，这些试验中 EVT 前静脉溶栓（IVT）的使用率较低，这对这种治疗在这种情况下的附加价值提出了质疑。我们旨在研究单独 EVT 与 IVT+EVT 治疗 BAO 中风患者的疗效和安全性。
我们分析了 2015 年 1 月 1 日至 2021 年 12 月 31 日期间在法国 21 个中心接受 EVT 治疗的急性缺血性中风患者的血管内治疗缺血性中风登记处的前瞻性、观察性、多中心研究数据。我们纳入了 BAO 和/或颅内椎动脉闭塞的患者，并在倾向评分（PS）匹配后比较了单独接受 EVT 治疗的患者与 IVT+EVT 治疗的患者。用于 PS 的变量选择包括：中风前 mRS、血脂异常、糖尿病、抗凝、入院方式、基线 NIHSS 和 ASPECTS、麻醉类型和从症状发作到穿刺的时间。疗效结局为 90 天时改良 Rankin 量表（mRS）0-3 的良好功能结局和功能独立性（mRS 0-2）。安全性结局为 90 天时症状性颅内出血和全因死亡率。
在 385 名患者中，进行 PS 匹配后，有 243 名患者（134 名单独接受 EVT 和 109 名 IVT+EVT）被纳入。单独接受 EVT 与 IVT+EVT 之间在良好功能结局（调整比值比[aOR]比值为 1.27，95%置信区间[CI]为 0.68-2.37，p=0.45）和功能独立性（aOR 为 1.50，95%CI 为 0.79-2.85，p=0.21）方面无差异。两组之间症状性颅内出血和全因死亡率也相似（aOR 为 0.42，95%CI 为 0.10-1.79，p=0.24 和 aOR 为 0.56，95%CI 为 0.29-1.10，p=0.09）。
在这项 PS 匹配分析中，单独 EVT 似乎与 IVT+EVT 一样能带来类似的神经恢复，且安全性相当。然而，考虑到我们的样本量和这项研究的观察性质，需要进一步的研究来证实这些发现。ANN NEUROL 2023；94：596-604。
