Is Bridging Necessary? A Pilot Study of Bridging versus Primary Stentriever-Based Endovascular Reperfusion in Large Anterior Circulation Strokes
Is Bridging Necessary? A Pilot Study of Bridging versus Primary Stentriever-Based Endovascular Reperfusion in Large Anterior Circulation Strokes
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.01.008
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发表时间：
2015-06-01
影响因子：
2.5
通讯作者：
Cohen, Jose E.
中科院分区：
文献类型：
--
作者：
Leker, Ronen R.;Pikis, Stelios;Cohen, Jose E.
背景资料：我们旨在确定桥接是否为大脑中动脉（pMCA）近端卒中患者提供了优于基于支架取栓器的初次血管内再灌注（SER）的额外受益。方法：分析连续脑卒中患者累及pMCA的大面积前循环梗死的临床和影像学资料。根据试验ORG 10172急性卒中治疗标准对卒中亚型进行分类。采用美国国立卫生研究院卒中量表（NIHSS）评估神经功能缺损，并在SER结束时采用脑梗死溶栓量表确定血管再通。良好结局定义为改良兰金量表（mRS）评分≤ 2分。结果：纳入57例患者，中位年龄为66岁。其中，24名患者既往接受过全身组织纤溶酶原激活剂治疗，33名患者接受过原发性SER治疗。房颤在接受SER治疗的患者中更常见，但在基线变量、手术相关变量或结局参数方面没有其他组间差异。6例患者死亡，27例患者在90天时达到2或更低的mRS。在SER之前接受tPA治疗的患者需要较少的支架取栓器通过来再通闭塞血管，但桥接并不影响生存率或有利结局的机会。年龄（比值比[OR]，0.92; 95%置信区间[CI]，0.85 - 0.98）和NIHSS评分（OR，0.12; 95% CI，0.02 - 0.78）是多变量分析中与结局相关的唯一变量。结论：原发性SER和桥接术同样具有较高的生存率和良好的预后。我们的研究结果表明，原发性SER在这些危重患者中的益处可能会绕过桥接治疗的需要，值得进一步研究。(C)2015年：National Stroke Association
Background: We aimed to determine whether bridging provides additional benefits over primary stentriever-based endovascular reperfusion (SER) in patients with proximal middle cerebral artery (pMCA) strokes. Methods: Clinical and radiologic data from consecutive stroke patients with large anterior circulation infarcts involving the pMCA were analyzed. Stroke subtypes were categorized according to Trial of ORG 10172 in Acute Stroke Treatment criteria. Neurologic deficits were assessed with the National Institutes of Health Stroke Scale (NIHSS), and vessel recanalization was determined using the Thrombolysis in Cerebral Infarction scale at the end of SER. Good outcome was defined as a modified Rankin Scale (mRS) score of 2 or lesser. Results: Fifty-seven patients with a median age of 66 years were included. Of those, 24 received prior systemic tissue plasminogen activator and 33 received primary SER. Atrial fibrillation was more common in patients who underwent SER but there were no other between-group differences in baseline variables, procedure-related variables, or outcome parameters. Six patients died and 27 patients achieved an mRS of 2 or less at 90 days. Patients who were treated with tPA before SER needed less stentriever passes to recanalize the occluded vessel, but bridging did not impact the chances for either survival or favorable outcome. Age (odds ratio [OR], .92; 95% confidence interval [CI], .85-.98) and NIHSS score (OR, .12; 95% CI, .02-.78) were the only variables associated with outcome on multivariate analysis. Conclusions: Primary SER and bridging resulted in equally high survival and good outcome rates. Our results suggest that the benefits of primary SER in such critically ill patients may bypass the need for bridging therapy and merit further study. (C) 2015 by National Stroke Association