急性缺血性卒中血管内血栓切除术的溶栓至穿刺时间与预后的关系

Relationship Between Thrombolysis-to-Puncture Time and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke.

作者信息

Tong Xu, Jia Baixue, Ma Gaoting, Zhang Xuelei, Fiehler Jens, Flottmann Fabian, Bechstein Matthias, Broocks Gabriel, Hanning Uta, Kniep Helge C, Thomalla Götz, Deb-Chatterji Milani, Schön Gerhard, Zhang Yijun, Gao Feng, Ma Ning, Mo Dapeng, Miao Zhongrong, Meyer Lukas

机构信息

Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China.

Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, China.

出版信息

Neurol Clin Pract. 2025 Aug;15(4):e200434. doi: 10.1212/CPJ.0000000000200434. Epub 2025 Jul 11.

DOI:10.1212/CPJ.0000000000200434

PMID:40656129

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12253961/

Abstract

BACKGROUND AND OBJECTIVES

Intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT) improves functional outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). There are limited data on the effect of thrombolysis-to-puncture time (TTP) on outcomes in patients with AIS undergoing IVT plus EVT.

METHODS

We selected 1,104 patients receiving IVT + EVT for anterior circulation LVO stroke from 2 prospective nationwide registries (259 cases from ANGEL-ACT in China: November 2017 to March 2019, 845 cases from German Stroke Registry-Endovascular Treatment in Germany: June 2015 to December 2019). Based on the TTP, eligible patients were divided into 4 groups (≤30 min, 31-50 min, 51-70 min, and >70 min). The radiologic and clinical outcomes (e.g., successful recanalization [modified Thrombolysis in Cerebral Infarction score of 2b-3] at final angiogram, modified Rankin Scale [mRS] score of 0-2 at 90 days, any intracranial hemorrhage [ICH], and symptomatic ICH within 24 hours) among the 4 groups were compared by χ tests for trend and using multivariable logistic regression models.

RESULTS

In the 4 groups from ≤30 min to >70 min, 226, 282, 230, and 366 patients were included, respectively. An increased TTP was associated with a lower chance of successful recanalization ( = 0.016) and mRS score 0-2 ( = 0.002). Compared with the group of ≤30 min, the group of >70 min was less likely to achieve successful recanalization (adjusted odds ratio [OR] = 0.47, 95% CI 0.25-0.89) and the groups of 50-70 min and >70 min had a reduced probability of mRS score 0-2 (adjusted OR = 0.50, 95% CI 0.33-0.78; adjusted OR = 0.56, 95% CI 0.37-0.85). No significant differences were found for any ICH or symptomatic ICH among the 4 groups after adjustment with potential confounders.

DISCUSSION

Delay from thrombolysis to puncture should be minimized when considering bridging IVT before EVT for patients with AIS due to anterior circulation LVO. Further studies are warranted to verify and expand on these findings.

TRIAL REGISTRATION INFORMATION

ClinicalTrials.gov, NCT03370939 and NCT03356392.

摘要

背景与目的

静脉溶栓（IVT）后行血管内血栓切除术（EVT）可改善由大血管闭塞（LVO）所致急性缺血性卒中（AIS）患者的功能预后。关于溶栓至穿刺时间（TTP）对接受IVT加EVT的AIS患者预后影响的数据有限。

方法

我们从2项全国性前瞻性登记研究中选取了1104例因前循环LVO卒中接受IVT+EVT治疗的患者（中国ANGEL-ACT研究中的259例：2017年11月至2019年3月；德国德国卒中登记-血管内治疗研究中的845例：2015年6月至2019年12月）。根据TTP，符合条件的患者被分为4组（≤30分钟、31 - 50分钟、51 - 70分钟和>70分钟）。通过趋势χ检验和多变量逻辑回归模型比较这4组患者的影像学和临床结局（例如，最终血管造影时成功再通[改良脑梗死溶栓评分2b - 3]、90天时改良Rankin量表[mRS]评分为0 - 2、任何颅内出血[ICH]以及24小时内症状性ICH）。

结果

在从≤30分钟到>70分钟的4组中，分别纳入了226、282、230和366例患者。TTP延长与成功再通的机会降低（P = 0.016）和mRS评分为0 - 2降低（P = 0.002）相关。与≤30分钟组相比，>70分钟组成功再通的可能性较小（调整后的优势比[OR]=0.47，95%可信区间0.25 - 0.89），50 - 70分钟组和>70分钟组mRS评分为0 - 2的概率降低（调整后的OR = 0.50，95%可信区间0.33 - 0.78；调整后的OR = 0.56，95%可信区间0.37 - 0.85）。在对潜在混杂因素进行调整后，4组之间在任何ICH或症状性ICH方面均未发现显著差异。