Aggressive therapy with intravenous Abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion - Combined local fibrinolysis and intravenous Abciximab in acute vertebrobasilar stroke treatment (FAST)

DOI：

10.1161/01.str.0000165918.80812.1e

发表时间：

2005-06-01

期刊：

STROKE

影响因子：

8.3

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Eckert, B;Koch, C;Zeumer, H

背景与目的：局部重组组织型纤溶酶原激活剂（rtPA）纤溶和静脉注射阿昔单抗血小板抑制联合经皮腔内血管成形术(PTA)/支架植入术可能改善急性椎基底动脉闭塞患者的再通和神经系统预后。方法FAST联合治疗方法为：静脉滴注阿昔单抗（0.25 mg/kg），随后以0.125 μ g/kg / min的速度滴注12小时，同时动脉内小剂量rtPA（中位剂量：20 mg， FAST队列：N = 47）。结果与动脉内rtPA单药治疗（中位剂量：40mg， rtPA队列，N = 41）的回顾性队列进行比较。如果出现严重的残余狭窄，则进行额外的PTA/支架置入。再通成功根据心肌梗死试验（TIMI）标准进行分类：TIMI /1，再通失败；TIMI2/3，再通成功。根据严重脑出血（ECH）、无症状脑出血（AIH）和有症状脑出血（SIH）来评估出血并发症。结果：在联合治疗下，总体出血率更高，但SIH率没有差异（FAST与rtPA: ECH， 3%对0%；AIH， 32%对22%；SIH， 13%对12%）。在14例（FAST）和5例（rtPA）患者中进行了额外的PTA/支架植入。两组患者TIMI2/3再通率相似（FAST, 72%; rtPA, 68%），但联合治疗组TIMI3再通率明显高于联合治疗组（FAST, 45%; rtPA, 22%）。联合治疗下神经系统预后更好（FAST与rtPA：良好转归率：34%对17%），死亡率显著降低（FAST与rtPA: 38%对68%；P = 0.006）。这些结果与栓塞性和动脉粥样硬化性血栓闭塞一致。结论：静脉注射阿昔单抗和半剂量动脉内rtPA联合额外的PTA/支架植入术似乎可以改善急性椎基底动脉闭塞的神经系统预后，尽管总体出血并发症增加。

Background and Purpose-A combined therapy of local recombinant tissue plasminogen activator (rtPA) fibrinolysis and intravenous Abciximab platelet inhibition with additional percutaneous transluminal angioplasty (PTA)/stenting may improve recanalization and neurological outcome in patients with acute vertebrobasilar occlusion.MethodsCombined FAST therapy consisted on intravenous bolus of Abciximab (0.25 mg/kg) followed by a 12-hour infusion therapy (0.125 mu g/kg per minute) and low-dose intra-arterial rtPA (median dosage: 20 mg, FAST cohort: N = 47). The results were compared with a retrospective cohort, treated by intraarterial rtPA monotherapy (median dosage: 40 mg, rtPA cohort, N = 41). Additional PTA/stenting was performed in case of severe residual stenosis. Recanalization success was classified according to the Trials in Myocardial Infarction (TIMI) criteria: TIMI0/1, failed recanalization; TIMI2/3, successful recanalization. Bleeding complications were evaluated according to severe extracerebral hemorrhage (ECH), asymptomatic intracerebral hemorrhage (AIH), and symptomatic intracerebral hemorrhage (SIH).Results-Overall bleeding rate was higher under the combined therapy, but the SIH rate did not differ ( FAST versus rtPA: ECH, 3% versus 0%; AIH, 32% versus 22%; SIH 13% versus 12%). Additional PTA/stenting was performed in 14 (FAST) versus 5 (rtPA) patients. TIMI2/3 recanalization rate was similar (FAST, 72%; rtPA, 68%), but TIMI3 rate was remarkably higher under combined therapy (FAST, 45%; rtPA, N = 22%). Neurologic outcome appeared better under combined therapy ( FAST versus rtPA: favorable outcome rate: 34% versus 17%) with a significantly lower mortality rate (FAST versus rtPA: 38% versus 68%; P = 0.006). These results were consistent for embolic and atherothrombotic occlusions.Conclusion-Combined therapy of intravenous Abciximab and half dose intra-arterial rtPA with additional PTA/stenting appears to improve neurologic outcome in acute vertebrobasilar occlusion despite an increase of overall bleeding complications.

Aggressive therapy with intravenous Abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion - Combined local fibrinolysis and intravenous Abciximab in acute vertebrobasilar stroke treatment (FAST) - Results of a multicenter study

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