From the Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, Mass (A.A.D., R.W.R., C.J.S., J.D.R., A.B.P.); Departments of Medical Imaging and Neurosurgery, Neurovascular Centre, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8 (A.A.D., N.M.C., T.R.M., V.M.P.); Departments of Neurologic Surgery & Radiology, Mayo Clinic, Rochester, Minn (S.G., H.K., R.K.); Cooper Neurologic Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ (J.E.S., H.S., J.K., A.J.T., A.G.); Departments of Radiology & Neurology, Boston Medical Center, Boston, Mass (M.A., P. Klein, T.N.N.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, Calif (J.J.H.); Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa (K.E.N., A.A., S.I.T., P.J.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, La (H.A.S., B.M., N.A., H.H.C.S.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.M., J.F. T.D.F.); Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.); Department of Neuroradiology, University Hospital of Limoges, Université de Limoges, Limoges, France (G.F., A.R., S. Saleme, C.M.); Department of Radiology, Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.L.K., A.S.P.); Department of Neuroradiology, Sana Kliniken, Lübeck GmbH, Lübeck, Germany (C.D.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.T.K., M.C.); Department of Interventional Neuroradiology, Bordeaux University Hospital, Bordeaux, France (G.M., J.B., X.B.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (I.S.); Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Mass (S.N., N.H.); Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Mass (N.H.); Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (N.H.); Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan (T.O., S.D.); Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Medicine, Division of Neurology, National University Hospital, Singapore (B.Y.Q.T.); Department of Neurology, UTHealth McGovern Medical School, Houston, Tex (J.C.M.G., S.S.M.); Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy (S. Sheth, L.R., C.C.); Department of Neurologic Surgery, Division of Stroke and Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif (A.M.); Department of Endovascular Neurosurgery and Neuroradiology, Rutgers University New Jersey Medical School in Newark, Newark, NJ (P. Khandelwal); Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY (A.B.); Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University, Paris, France (F.C., M.E., K.P.); Neurology Department, Faculty of Medicine, Tanta University, Egypt (M.E.); UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy (I.V., A.P., A.M.A.); Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal (J.P.F.); Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal (R.V.); Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, Calif (M.Q.C., N.R.G.); Department of Vascular and Interventional Neuroradiology, Universitätsklinikum Heidelberg, Heidelberg, Germany (M.A.M., J.J., C.W.); Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (V.C., R.A.R.); Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (A.t.S.); Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Md (V.Y.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio (P.H., L.M.C., Y.A.); Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France (B.G.); INSERM U1254, IADI, Université de Lorraine, Nancy, France (B.G.); Department of Radiology, Section of Interventional Neuroradiology, University Medical Center Münster, Münster, Germany (C.P.S.); Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria (C.H., M.K.O., C.J.G.); Department of Neurology, Sin-Lau Hospital, Tainan, Taiwan (C.Y.H.); UCLA Stroke Center and Department of Neurology Department, University of California Los Angeles, Los Angeles, Calif (D.S.L.); Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada (I.T., R.F.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (B.L.).
Radiology. 2024 Aug;312(2):e233041. doi: 10.1148/radiol.233041.
Background The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion. Purpose To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion. Materials and Methods This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes. Results After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, < .001) and onset to recanalization (397 vs 273 minutes, < .001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; = .019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; = .054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; = .17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; = .055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; = .16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; = .29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; = .21). Conclusion Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. © RSNA, 2024 See also the editorial by Wojak in this issue.
静脉溶栓（IVT）联合机械取栓（MT）可能对中等大小血管闭塞的患者具有临床获益。目的：探讨急性缺血性脑卒中（AIS）伴中等大小血管闭塞患者接受 MT 联合 IVT 是否比单独接受 MT 具有更好的结局。材料与方法：本回顾性研究纳入了在北美、亚洲和欧洲的 37 家学术中心接受 MT 或 MT 联合 IVT 治疗的连续成年 AIS 伴中等大小血管闭塞患者。数据收集时间为 2017 年 9 月至 2021 年 7 月。采用倾向性评分匹配以减少混杂因素。采用单变量和多变量逻辑回归分析检验 IVT 治疗的附加与不同功能和安全性结局之间的关联。结果：经倾向性评分匹配后，纳入 670 例患者（中位年龄 75 岁[IQR，6482 岁]；356 例女性）进行分析；335 例患者接受单独 MT 治疗，335 例患者接受 MT 联合 IVT 治疗。MT 组的中位发病至穿刺时间（350 分钟比 210 分钟， <.001）和发病至再通时间（397 分钟比 273 分钟， <.001）均长于 MT 联合 IVT 组。单变量回归分析显示，IVT 的附加治疗与改良 Rankin 量表（mRS）评分 02 分的可能性更高相关（比值比[OR]，1.44；95%CI：1.06，1.96； =.019）；然而，多变量分析未显示出这种关联（OR，1.37；95%CI：0.99，1.89； =.054）。多变量分析还显示，IVT 的附加治疗与首次通过效应（OR，1.27；95%CI：0.90，1.79； =.17）、血栓切除术治疗脑梗死 2b-3 级（OR，1.64；95%CI：0.99，2.73； =.055）、mRS 评分 0~1 分（OR，1.27；95%CI：0.91，1.76； =.16）、死亡率（OR，0.78；95%CI：0.49，1.24； =.29）或颅内出血（OR，1.25；95%CI：0.88，1.76； =.21）无关。结论：在由远端和中等大小血管闭塞引起的 AIS 患者中，辅助 IVT 可能无法为 MT 带来获益。
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