Sun Wenzhe, Ma Jinfu, Xu Xu, Zhao Yuan, Huang Jiacheng, Guo Changwei, Zhang Lingyu, Yu Nizhen, Yue Chengsong, Zi Wenjie, Zhu Minzhen, He Jinzhao
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing.
Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, Guangdong Province, China.
Int J Surg. 2025 Jan 1;111(1):520-528. doi: 10.1097/JS9.0000000000002017.
Whether patients with large core infarctions should undergo intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) is currently a subject of controversy. The study aimed to investigate the association of prior use of IVT with outcomes of EVT patients with large core infarctions.
This prospective cohort included patients with acute large vessel occlusion and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 0-5 from 38 stroke centers across China between November 2021 and February 2023. The primary outcome was defined as favorable functional outcomes, which is 90-day modified Rankin Scale (mRS) scores ranging from 0 to 3. Procedural outcomes included measures of successful and effective recanalization. Safety outcomes included the incidence of any intracranial hemorrhage (ICH), symptomatic ICH, and 90-day mortality.
Of 490 patients, 122 (24.5%) were treated with IVT before EVT. Bridging therapy and its transfer modes showed no association with any of the measured outcomes. Compared to direct EVT, bridging therapy was associated with a decreased risk of symptomatic ICH in very elderly patients and a decreased risk of any ICH in patients with admission NIHSS scores of 20 or higher. Additionally, early stroke severity may alter the odds of any ICH in patients with bridging therapy versus direct EVT (inverse probability weighting adjusted P value for interaction=0.003 and 0.007, respectively).
In large core infarction patients with high admission NIHSS or very elderly age, bridging therapy appears to have some advantages over direct EVT in reducing the risk of ICH.
大面积梗死患者在血管内血栓切除术（EVT）前是否应接受静脉溶栓（IVT）目前存在争议。本研究旨在调查预先使用IVT与大面积梗死EVT患者结局之间的关联。
这项前瞻性队列研究纳入了2021年11月至2023年2月期间来自中国38个卒中中心的急性大血管闭塞且阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）为0 - 5分的患者。主要结局定义为良好的功能结局，即90天改良Rankin量表（mRS）评分为0至3分。手术结局包括成功再通和有效再通的指标。安全结局包括任何颅内出血（ICH）、症状性ICH的发生率以及90天死亡率。
在490例患者中，122例（24.5%）在EVT前接受了IVT治疗。桥接治疗及其转运方式与任何测量结局均无关联。与直接EVT相比，桥接治疗在高龄患者中与症状性ICH风险降低相关，在入院美国国立卫生研究院卒中量表（NIHSS）评分≥20分的患者中与任何ICH风险降低相关。此外，早期卒中严重程度可能改变接受桥接治疗与直接EVT患者发生任何ICH的几率（交互作用的逆概率加权调整P值分别为0.003和0.007）。
在入院NIHSS评分高或年龄极高的大面积梗死患者中，桥接治疗在降低ICH风险方面似乎比直接EVT具有一些优势。
