Revascularization results in the interventional management of stroke II trial
Revascularization results in the interventional management of stroke II trial
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DOI：
10.3174/ajnr.a0843
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发表时间：
2008-03-01
影响因子：
3.5
通讯作者：
Khoury, J.
中科院分区：
文献类型：
--
作者：
Tomsick, T.;Broderick, J.;Khoury, J.
背景和目的：我们的目的是在卒中介入治疗（IMS）II试验中详细描述血运重建结果，包括对结局和死亡率的影响。材料和方法：IMS II旨在通过EKOS Primo Micro获得对减少剂量的静脉注射重组组织纤溶酶原激活剂（rtPA），随后进行额外的动脉内rtPA和低能量超声检查的疗效和安全性的估计。在发病后3小时内接受治疗的缺血性卒中选定患者中，闭塞处的输注导管。详细描述了血运重建结局，并与改良兰金量表评分0-2分、死亡率结局和IMS I的结果进行了比较。结果：超声微导管治疗的29例闭塞中有12例（41.4%）在60分钟时完全再通。超声导管治疗组20/29例（68.9%）在2小时或手术结束时实现完全再通，18/29例（62.0%）超声治疗受试者实现脑梗死最终溶栓（TICI）2/3再灌注。15分钟血管造影显示，在69/145（46.7%）例超声微导管治疗间期中有一定程度的再通，而在23例具有可靠15分钟血管造影的受试者中，MS I治疗间期为39/111（35.1%）（P = 0.046）。汇总的IMS I-II数据表明，56/75例（74.6%）颈内动脉T和MI闭塞发生部分或完全再通，46/75例（61.3%）发生良好再灌注（TICI 2/3）。血运重建与TICI 2/3再灌注的良好结局相关（P = .0004），TICI 2B/3再灌注（P = .0002），动脉闭塞性病变2/3再通结论：IMS II提供的证据表明，与标准微导管相比，EKOS Primo超声微导管显示出改善闭塞再通的趋势，并再次证实了再通和再灌注之间的相关性具有良好的临床结局和降低的死亡率。
BACKGROUND AND PURPOSE: Our aim was to detail revascularization results, including impact on outcome and mortality, in the Interventional Management of Stroke (IMS) II trial.MATERIALS AND METHODES: IMS II was designed to obtain estimates of the efficacy and safety of reduced-dose intravenous recombinant tissue plasminogen activator (rtPA) followed by additional intra-arterial rtPA and low-energy sonography via the EKOS Primo Micro-Infusion Catheter at the occlusion in selected patients with ischemic stroke treated within 3 hours of onset. Revascularization outcomes were detailed and compared with modified Rankin Scale scores 0-2, mortality outcomes, and results from IMS I.RESULTS: Complete recanalization at 60 minutes occurred in 12 of 29 (41.4%) sonography microcatheter-treated occlusions. Complete recanalization was achieved at 2 hours or procedure end in 20/29 (68.9%) in the ultrasound catheter-treated group, and final thrombolysis in cerebral infarction (TICI) 2/3 reperfusion was achieved in 18/29 (62.0%) ultrasound-treated subjects. Fifteen-minute angiograms demonstrated some recanalization in 69/145 (46.7%) sonography microcatheter treatment intervals, compared with 39/111 (35.1%) in MS I treatments in 23 subjects with reliable 15-minute angiograms (P = .046). Pooled IMS I-II data demonstrated that partial or complete recanalization occurred in 56/75 (74.6%) and good reperfusion (TICI 2/3) occurred in 46/75 (61.3%) of internal carotid artery T and MI occlusions. Revascularization correlated with good outcome for TICI 2/3 reperfusion (P = .0004), TICI 2B/3 reperfusion (P = .0002), and arterial occlusive lesion 2/3 recanalization (P = .03).CONCLUSION: IMS II provides evidence that the EKOS Primo sonography microcatheter exhibits a trend toward improved recanalization of the occlusion compared with a standard microcatheter and again confirms the correlation between recanalization and reperfusion with good clinical outcome and reduced mortality.