静脉溶栓联合机械取栓治疗的急性缺血性卒中患者门-针时间与预后的关联：来自意大利急性卒中血管内治疗注册研究（IRETAS）的分析
Association between door-to-needle time and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis plus mechanical thrombectomy: Analysis from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
作者信息
Sallustio Fabrizio, Mascolo Alfredo Paolo, Marrama Federico, Diomedi Marina, Lacidogna Giordano, D'Agostino Federica, Alemseged Fana, Da Ros Valerio, Sabuzi Federico, Fainardi Enrico, Casetta Ilaria, Vallone Stefano, Bigliardi Guido, Allegretti Luca, Coco Elena, Lafe Elvis, Longoni Marco, Semeraro Vittorio, Boero Giovanni, Petralia Benedetto, Cappellari Manuel, Nicolini Ettore, Ciacciarelli Antonio, Romano Daniele Giuseppe, Napoletano Rosa, Boghi Andrea, Naldi Andrea, Saletti Andrea, De Vito Alessandro, Vinci Sergio Lucio, Ferraù Ludovica, Zimatore Domenico Sergio, Petruzzellis Marco, Bergui Mauro, Bosco Giovanni, Gallesio Ivan, Ferrandi Delfina, Cosottini Mirco, Giannini Nicola, Comai Alessio, Dall'Ora Elisa, Barchetti Giovanni, Caggiula Marcella, Cavasin Nicola, Critelli Adriana, Perri Marco, De Santis Federica, Galluzzo Simone, Zini Andrea, Zilahi De Gyurgyokai Simone, Loizzo Nicola, Menozzi Roberto, Pezzini Alessandro, Sponza Massimo, Merlino Giovanni, Filizzolo Marco, Mannino Marina, Carità Giuseppe, Russo Monia, Allegritti Massimiliano, Caproni Stefano, Besana Michele, Giossi Alessia, Cioni Samuele, Tassi Rossana, Galvano Gianluca, Saracco Eleonora, Limbucci Nicola, Puglielli Edoardo, Casalena Alfonsina, Mangiafico Salvatore, Toni Danilo
机构信息
Unità Di Trattamento Neurovascolare, Ospedale Dei Castelli-ASLRoma6, Rome, Italy.
Comprehensive Stroke Center, Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
出版信息
Eur Stroke J. 2025 Sep 14:23969873251368720. doi: 10.1177/23969873251368720.
INTRODUCTION
We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
MATERIALS AND METHODS
Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.
RESULTS
About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02-1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6-4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21-2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43-0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08-0.67; OR 0.45; 95% CI 0.29-0.72; OR 0.58; 95% CI 0.39-0.84; respectively).
CONCLUSIONS
In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.
引言
我们旨在评估意大利急性卒中血管内治疗注册研究（IRETAS）中接受静脉溶栓（IVT）+机械取栓（MT）治疗的急性缺血性卒中（AIS）患者群体中，门到针时间（DTN）与预后之间的关联。
材料与方法
纳入因大脑中动脉或颅内颈内动脉闭塞继发AIS且症状发作时间已知、直接前往具备MT治疗能力中心就诊的患者进行分析。根据预先定义的DTN截止值（≤30、≤45和≤60分钟），我们通过多变量逻辑回归分析评估DTN与预后之间的关联。有效性结局为3个月时功能独立、3个月时良好结局和成功再灌注。安全性结局为任何颅内出血（ICH）、症状性脑出血（sICH）和3个月死亡率。
结果
约1602例患者纳入我们的分析。经过逻辑回归分析，DTN≤60分钟与3个月时功能独立显著相关（比值比[OR]1.36；95%置信区间[CI]1.02 - 1.82）。DTN≤30、≤45和≤60分钟与成功再灌注显著相关（分别为OR 2.66；95%CI 1.6 - 4.43；OR 1.68；95%CI 1.25 - 2.26；OR 1.57；95%CI 1.21 - 2.05）。DTN≤60分钟也与任何ICH发生率较低显著相关（OR 0.61；95%CI 0.43 - 0.86）。DTN≤30、≤45和≤60分钟与3个月死亡率较低显著相关（分别为OR 0.24；95%CI 0.08 - 0.67；OR 0.45；95%CI 0.29 - 0.72；OR 0.58；95%CI 0.39 - 0.84）。
结论
在接受IVT + MT治疗的AIS患者中，如果在入院后1小时内开始IVT，较短的DTN与更好的预后相关。
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