Acute Ischemic Stroke
Acute Ischemic Stroke
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DOI：
10.1212/wnl.0000000000206841
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发表时间：
2022-12
期刊：
影响因子：
9.9
通讯作者：
C. Cronin
中科院分区：
文献类型：
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作者：
C. Cronin
自1995年国家神经疾病和卒中研究所重组组织纤溶酶原激活剂试验发表以来，静脉溶栓（IVT）一直是符合条件的急性缺血性卒中（AIS）患者的标准治疗。当血管内血栓切除术（EVT）被证明有利于治疗继发于大血管闭塞（LVO）的AIS时，这就提出了一个问题，即走向EVT的患者是否应首先继续接受IVT治疗。由于IVT是进行显示EVT获益的关键试验时的标准治疗，因此这些研究中纳入的大多数患者在EVT前接受IVT。在过去的2年中，4项随机临床试验评价了在能够提供EVT的中心就诊的患者中，EVT单独与EVT前IVT的相对疗效和安全性。其中2项试验符合EVT与IVT和EVT联合治疗相比的非劣效性的预定阈值1、2，2项试验不符合其非劣效性阈值。3，4
IV thrombolysis (IVT) has been the standard-of-care treatment for eligible patients with acute ischemic stroke (AIS) since publication of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trial in 1995. When endovascular thrombectomy (EVT) was shown to be beneficial for treatment of AIS secondary to large vessel occlusion (LVO), this raised the question of whether patients heading toward EVT should continue to be treated with IVT first. As IVT was the standard of care at the time that the pivotal trials showing benefit of EVT were performed, most of the patients included in those studies received IVT before EVT. Over the past 2 years, 4 randomized clinical trials have evaluated the relative efficacy and safety of EVT alone vs IVT before EVT in patients who present to a center capable of providing EVT. Two of these trials met their prespecified threshold for noninferiority of EVT compared with combined IVT and EVT1,2 and 2 trials did not meet their noninferiority thresholds.3,4