Xu Bin, Yin Tengkun, Sun Tanggui, Lv Hang, Zhang Wenyv, Zan Xv, Hao Jiheng, Wang Jiyue, Zhang Liyong
Neurosurgery Department, Liaocheng People's Hospital, Liaocheng, China.
School of Clinical Medicine, Weifang Medical University, Weifang, China.
Front Neurol. 2024 Aug 21;15:1321909. doi: 10.3389/fneur.2024.1321909. eCollection 2024.
The administration of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) has been a subject of debate, and its potential benefits remain uncertain. This retrospective study aimed to investigate the effect of preoperative IVT on glycocalyx damage in patients with cerebral ischemia-reperfusion injury (IRI).
A cohort of 106 patients with acute large vessel occlusion in the anterior circulation treated with mechanical thrombectomy was enrolled. The levels of the glycocalyx damage marker, syndecan-1, were measured in the peripheral blood of these patients to assess glycocalyx damage during IRI, and clinical outcomes were compared between patients receiving MT alone vs. combined IVT and MT.
The study results indicate that thrombolytic drugs have a significant impact on syndecan-1 levels in the blood. Compared to patients who underwent direct MT, those who received preoperative IVT had significantly lower levels of syndecan-1 in their blood. Although preoperative IVT did not alter the final clinical outcomes, the levels of syndecan-1 shedding reflect the extent of damage to the endothelial glycocalyx.
This suggests that using thrombolytic drugs before mechanical thrombectomy may reduce endothelial glycocalyx damage in patients with ischemia-reperfusion injury. These findings provide indirect clinical evidence supporting the preoperative use of intravenous thrombolysis in such patients.
在急性缺血性卒中（AIS）治疗中，在机械取栓（MT）前进行静脉溶栓（IVT）一直存在争议，其潜在益处仍不确定。这项回顾性研究旨在调查术前IVT对脑缺血再灌注损伤（IRI）患者糖萼损伤的影响。
纳入106例接受机械取栓治疗的急性前循环大血管闭塞患者。测量这些患者外周血中糖萼损伤标志物syndecan-1的水平，以评估IRI期间的糖萼损伤，并比较单纯接受MT的患者与接受IVT联合MT的患者的临床结局。
研究结果表明，溶栓药物对血液中syndecan-1水平有显著影响。与直接接受MT的患者相比，接受术前IVT的患者血液中syndecan-1水平显著较低。虽然术前IVT并未改变最终临床结局，但syndecan-1脱落水平反映了内皮糖萼的损伤程度。
这表明在机械取栓前使用溶栓药物可能会减少缺血再灌注损伤患者的内皮糖萼损伤。这些发现提供了间接临床证据，支持在此类患者中术前使用静脉溶栓。
