Gonsales Douglas, Figueiredo Eberval Gadelha, Telles Joao Paulo Mota, Aguilar-Salinas Pedro, Aghaebrahim Nima Amin, Sauvageau Eric, da Silva Saul Almeida, Hanel Ricardo A
Department of Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, United States.
Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Sao Paulo, Brazil.
Surg Neurol Int. 2024 Aug 30;15:308. doi: 10.25259/SNI_365_2024. eCollection 2024.
This study aims to address the safety and efficacy of mechanical thrombectomy (MT) in acute ischemic stroke with an established infarction equal to or >50 mL with a significant difference between penumbra and established infarction detected by perfusion cerebral computed tomography (CT) with the Rapid system.
This was a retrospective case-control study. Patients diagnosed with established and extensive ischemic stroke, defined by an ischemic volume equal to or >50 mL on CT or magnetic resonance imaging perfusion using the RAPID system, were examined. The intervention group received endovascular interventional treatment with or without recombinant tissue plasminogen activator (rt-PA) in addition to standard therapy, and the control group received conservative treatment with or without rt-PA plus standard therapy.
A total of 59 patients were enrolled, including 38 in the intervention group and 21 in the control group. Baseline characteristics were similar between groups. Patient National Institutes of Health Stroke Scale at discharge was significantly different between the control (median 30, interquartile range [IQR] 13) and intervention group (median 8, IQR 14) ( < 0.001). Modified Rankin scale (mRS) scores were significantly different at discharge between intervention (median mRS 2, IQR 3) and controls (median mRS 5, IQR 1) ( = 0.002). These mRS differences remained significant at 90 days, with median (IQR) values of 2 (2.75) and 5 (1), respectively ( < 0.001).
MT is safe and effective for large-core ischemic strokes with significant perfusion mismatch, leading to better functional outcomes without significant complications compared to the best medical treatment.
本研究旨在探讨机械取栓术（MT）治疗急性缺血性卒中的安全性和有效性，这些患者的梗死灶已形成且体积等于或大于50 mL，通过快速系统的灌注脑计算机断层扫描（CT）检测到半暗带和已形成梗死灶之间存在显著差异。
这是一项回顾性病例对照研究。对诊断为已形成且广泛的缺血性卒中患者进行检查，这些患者通过RAPID系统在CT或磁共振成像灌注上显示缺血体积等于或大于50 mL。干预组除标准治疗外，接受血管内介入治疗，可联合或不联合重组组织型纤溶酶原激活剂（rt-PA），对照组接受保守治疗，可联合或不联合rt-PA加标准治疗。
共纳入59例患者，其中干预组38例，对照组21例。两组间基线特征相似。出院时，对照组（中位数30，四分位间距[IQR] 13）和干预组（中位数8，IQR 14）的患者美国国立卫生研究院卒中量表评分有显著差异（<0.001）。干预组（中位数改良Rankin量表[mRS] 2，IQR 3）和对照组（中位数mRS 5，IQR 1）出院时的mRS评分有显著差异（=0.002）。这些mRS差异在90天时仍显著，中位数（IQR）值分别为2（2.75）和5（1）（<0.001）。
对于存在显著灌注不匹配的大核心缺血性卒中，MT是安全有效的，与最佳药物治疗相比，能带来更好的功能结局且无显著并发症。
