Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke
Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke
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DOI：
10.1111/imj.14069
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发表时间：
2019-03-01
影响因子：
2.1
通讯作者：
Kok, Hong K.
中科院分区：
文献类型：
--
作者：
Maingard, Julian;Shvarts, Yasmin;Kok, Hong K.
背景资料：血管内血栓切除术（EVT）是目前治疗大血管闭塞（LVO）急性缺血性卒中的最佳实践。v.）的阿替普酶治疗可带来任何临床获益。方法：对接受EVT治疗的LVO患者进行回顾性研究。比较接受溶栓和EVT的患者与单独接受EVT的患者的结局。主要终点为再灌注率、90天功能结局和使用改良兰金量表（mRS）和症状性颅内出血（sICH）的死亡率。结果：共纳入355例接受EVT的患者：210例溶栓（59%），145例未溶栓（41%）。i组再灌注率较高。v.组织纤溶酶原激活剂（tPA）（未校正比值比（OR）2.2，95%置信区间（CI）：1.29-3.73，P = 0.004），尽管当考虑所有变量时，该效应减弱（校正OR（AOR）1.22，95% CI：0.60-2.5，P = 0.580）。接受桥接i的患者在90天时实现功能独立（mRS 0-2）的百分比较高。v. tPA（AOR 2.17，95% CI：1.06-4.44，P = 0.033）。严重并发症（包括sICH）无显著差异（AOR 1.4，95% CI：0.51-3.83，P = 0.512）。桥接组的90天死亡率较低。v. tPA组（AOR 0.79，95%CI：0.36-1.74，P = 0.551）。在i组中实现成功再灌注所需的血栓切除术次数较少（2 vs 3，P = 0.012）。v. tPA组。成功再灌注（脑梗死改良溶栓= 2b）是90天功能独立性的最强预测因子（AOR 10.4，95% CI：3.6-29.7，P < 0.001）。血管内治疗前静脉注射阿替普酶。
Background: Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke is now current best practice.Aim: To determine if bridging intravenous (i. v.) alteplase therapy confers any clinical benefit.Methods: A retrospective study of patients treated with EVT for LVO was performed. Outcomes were compared between patients receiving thrombolysis and EVT with EVT alone. Primary end-points were reperfusion rate, 90-day functional outcome and mortality using the modified Rankin Scale (mRS) and symptomatic intracranial haemorrhage (sICH).Results: A total of 355 patients who underwent EVT was included: 210 with thrombolysis (59%) and 145 without (41%). The reperfusion rate was higher in the group receiving i. v. tissue plasminogen activator (tPA) (unadjusted odds ratio (OR) 2.2, 95% confidence interval (CI): 1.29-3.73, P = 0.004), although this effect was attenuated when all variables were considered (adjusted OR (AOR) 1.22, 95% CI: 0.60-2.5, P = 0.580). The percentage achieving functional independence (mRS 0-2) at 90 days was higher in patients who received bridging i. v. tPA (AOR 2.17, 95% CI: 1.06-4.44, P = 0.033). There was no significant difference in major complications, including sICH (AOR 1.4, 95% CI: 0.51-3.83, P = 0.512). There was lower 90-day mortality in the bridging i. v. tPA group (AOR 0.79, 95% CI: 0.36-1.74, P = 0.551). Fewer thrombectomy passes (2 versus 3, P = 0.012) were required to achieve successful reperfusion in the i. v. tPA group. Successful reperfusion (modified thrombolysis in cerebral infarction = 2b) was the strongest predictor for 90-day functional independence (AOR 10.4, 95% CI: 3.6-29.7, P < 0.001).Conclusion: Our study supports the current practice of administering i. v. alteplase before endovascular therapy.