急性缺血性卒中原发性远端中等血管闭塞的血管内血栓切除术与静脉溶栓治疗对比
Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke.
作者信息
Salsano Giancarlo, Salsano Antonio, Del Sette Bruno, D'Alonzo Alessio, Sassos Davide, Alexandre Andrea, Pedicelli Alessandro, Di Iorio Riccardo, Colò Francesca, Castellan Lucio
机构信息
Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
DISC Department, University of Genova, Genoa, Italy.
出版信息
Open Med (Wars). 2024 May 13;19(1):20240966. doi: 10.1515/med-2024-0966. eCollection 2024.
INTRODUCTION
In the absence of clinical trials, the benefit of endovascular therapy (EVT) on the treatment of acute ischemic stroke (AIS) with primary distal and medium vessel occlusions (DMVO) is still not well defined. The aim of the study is to evaluate EVT with or without intravenous thrombolysis (EVT ± IVT) in primary DMVO stroke in comparison with a control cohort treated with IVT alone.
METHODS
We analysed all consecutive AIS with proven primary DMVO. Primary endpoints were excellent outcome, functional independence at 3 months follow-up, and early neurologic improvement at 1 day after treatment.
RESULTS
One hundred and fourteen patients with DMVO strokes were included between 2019 and 2023. Propensity-weighted analysis showed no significant differences in EVT ± IVT vs IVT for the excellent outcome (adjusted OR [aOR], 1.575; 95% CI, 0.706-3.513), functional independence (aOR, 2.024; 95% CI, 0.845-4.848), early neurological improvement (aOR, 2.218; 95% CI, 0.937-5.247), mortality (aOR, 0.498; 95% CI, 0.177-1.406), symptomatic intracranial haemorrhage (aOR, 0.493; 95% CI, 0.102-2.385), and subarachnoid haemorrhage (aOR, 0.560; 95% CI, 0.143-2.187). The type of revascularization did not influence the percentage of cerebral volume lost (adjusted linear regression estimate, -19.171, value, 11.562; = 0.104).
CONCLUSIONS
This study supports the hypothesis that patients with primary DMVO stroke treated with EVT (±IVT) or IVT alone have comparable outcomes.
引言
在缺乏临床试验的情况下，血管内治疗（EVT）对治疗伴有原发性远端和中等血管闭塞（DMVO）的急性缺血性卒中（AIS）的益处仍未明确界定。本研究的目的是评估在原发性DMVO卒中中，接受或未接受静脉溶栓（EVT±IVT）的血管内治疗与仅接受静脉溶栓治疗的对照队列相比的效果。
方法
我们分析了所有经证实为原发性DMVO的连续性急性缺血性卒中患者。主要终点为良好预后、随访3个月时的功能独立性以及治疗后1天的早期神经功能改善。
结果
2019年至2023年期间纳入了114例DMVO卒中患者。倾向评分加权分析显示，在良好预后（调整后的比值比[aOR]，1.575；95%置信区间[CI]，0.706 - 3.513）、功能独立性（aOR，2.024；95%CI，0.845 - 4.848）、早期神经功能改善（aOR，2.218；95%CI，0.937 - 5.247）、死亡率（aOR，0.498；95%CI，0.177 - 1.406）、症状性颅内出血（aOR，0.493；95%CI，0.102 - 2.385）和蛛网膜下腔出血（aOR，0.560；95%CI，0.143 - 2.187）方面，EVT±IVT与IVT之间无显著差异。血管再通类型并未影响脑体积丢失的百分比（调整后的线性回归估计值，-19.171，P值，11.562；P = 0.104）。
结论
本研究支持以下假设，即接受EVT（±IVT）或仅接受IVT治疗的原发性DMVO卒中患者具有相似的预后。
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