Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
J Thromb Thrombolysis. 2023 Oct;56(3):454-462. doi: 10.1007/s11239-023-02844-4. Epub 2023 Jun 28.
Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.5 h after symptom onset). Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analysed. We identified 409 IRETAS patients treated with IVT plus MT and 384 SITS-ISTR patients treated with IVT alone. IVT plus MT was significantly associated with higher rate of sICH (ECASS II) compared with IVT alone (3.1 vs 1.9%; OR 3.984, 95% CI 1.014-15.815), while the two treatments did not differ significantly in 3-month mRS score ≤ 3 (64.3 vs 74.1%; OR 0.829, 95% CI 0.524-1.311). In 389 patients with isolated basilar artery (BA) occlusion, IVT plus MT was significantly associated with higher rate of any ICH compared with IVT alone (9.4 vs 7.4%; OR 4.131, 95% CI 1.215-14.040), while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with higher rate mRS score ≤ 2 (69.1 vs 52.1%; OR 2.692, 95% CI 1.064-6.811) and lower rate of death (13.8 vs 27.1%; OR 0.299, 95% CI 0.095-0.942) in patients with distal-segment BA occlusion, while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with lower rate of mRS score ≤ 3 (37.1 vs 53.3%; OR 0.137, 0.009-0.987), mRS score ≤ 1 (22.9 vs 53.3%; OR 0.066, 95% CI 0.006-0.764), mRS score ≤ 2 (34.3 vs 53.3%; OR 0.102, 95% CI 0.011-0.935), and higher rate of death (51.4 vs 40%; OR 16.244, 1.395-89.209) in patients with proximal-segment BA occlusion. Compared with IVT alone, IVT plus MT was significantly associated with higher rate of sICH per ECASS II definition in patients with stroke and posterior circulation LVO, while two treatment groups did not differ significantly in 3-month mRS score ≤ 3. IVT plus MT was associated with lower rate of mRS score ≤ 3 compared with IVT alone in patients with proximal-segment BA occlusion, whereas no significant difference was found between the two treatments in primary endpoints in patients isolated BA occlusion and in the other subgroups based on site occlusion.
机械取栓（MT）治疗后循环大血管闭塞（LVO）卒中的疗效和安全性仍存在争议。我们旨在比较接受静脉溶栓（IVT）治疗（症状发作后 4.5 小时内）联合 MT 治疗（症状发作后 6 小时内）和单独接受 IVT 治疗（症状发作后 4.5 小时内）的后循环 LVO 卒中患者的结局。分析了意大利血管内治疗急性卒中登记处（IRETAS）和意大利 SITS-ISTR 中心的患者。我们共纳入 409 例接受 IVT 联合 MT 治疗的 IRETAS 患者和 384 例接受单独 IVT 治疗的 SITS-ISTR 患者。与单独 IVT 治疗相比，IVT 联合 MT 治疗与更高的 sICH（ECASS II）发生率显著相关（3.1%比 1.9%；OR 3.984，95%CI 1.014-15.815），但两种治疗方法在 3 个月 mRS 评分≤3 的患者中差异无统计学意义（64.3%比 74.1%；OR 0.829，95%CI 0.524-1.311）。在 389 例孤立基底动脉（BA）闭塞患者中，与单独 IVT 治疗相比，IVT 联合 MT 治疗与任何 ICH 发生率更高显著相关（9.4%比 7.4%；OR 4.131，95%CI 1.215-14.040），但两种治疗方法在 3 个月 mRS 评分≤3 和按 ECASS II 定义的 sICH 发生率方面差异无统计学意义。与单独 IVT 治疗相比，IVT 联合 MT 治疗与较高的 mRS 评分≤2 发生率（69.1%比 52.1%；OR 2.692，95%CI 1.064-6.811）和较低的死亡率（13.8%比 27.1%；OR 0.299，95%CI 0.095-0.942）显著相关，在孤立的 BA 远段闭塞患者中，两种治疗方法在 3 个月 mRS 评分≤3 和按 ECASS II 定义的 sICH 发生率方面差异无统计学意义。与单独 IVT 治疗相比，IVT 联合 MT 治疗与较低的 mRS 评分≤3 发生率（37.1%比 53.3%；OR 0.137，0.009-0.987）、mRS 评分≤1 发生率（22.9%比 53.3%；OR 0.066，95%CI 0.006-0.764）、mRS 评分≤2 发生率（34.3%比 53.3%；OR 0.102，95%CI 0.011-0.935）和较高的死亡率（51.4%比 40%；OR 16.244，1.395-89.209）显著相关，在孤立的 BA 近段闭塞患者中。与单独 IVT 治疗相比，IVT 联合 MT 治疗与更高的 sICH 发生率（按 ECASS II 定义）显著相关，在后循环 LVO 卒中患者中，而两种治疗组在 3 个月 mRS 评分≤3 方面差异无统计学意义。与单独 IVT 治疗相比，IVT 联合 MT 治疗与 BA 近段闭塞患者 mRS 评分≤3 的发生率较低显著相关，而在孤立的 BA 闭塞患者和其他基于部位闭塞的亚组中，两种治疗方法在主要终点方面无显著差异。
