Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion.

IF 12.1 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology Pub Date : 2024-08-01 DOI:10.1148/radiol.233041

Adam A Dmytriw, Sherief Ghozy, Hamza Adel Salim, Basel Musmar, James E Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Jeremy J Heit, Robert W Regenhardt, Nicole M Cancelliere, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S Puri, Christian Dyzmann, Peter T Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R Marotta, Christopher J Stapleton, James D Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L L Yeo, Benjamin Y Q Tan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Nimer Adeeb, Hugo H Cuellar-Saenz, Stavropoula I Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R Gonzalez, Markus A Möhlenbruch, Jessica Jesser, Vincent Costalat, Adrien Ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M Chervak, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J Griessenauer, Ajith J Thomas, Cheng-Yang Hsieh, David S Liebeskind, Răzvan Alexandru Radu, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Robert Fahed, Charlotte S Weyland, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego

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引用次数: 0

Abstract

Background The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion. Purpose To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion. Materials and Methods This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes. Results After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, P < .001) and onset to recanalization (397 vs 273 minutes, P < .001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; P = .019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; P = .054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; P = .17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; P = .055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; P = .16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; P = .29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; P = .21). Conclusion Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Wojak in this issue.

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对急性缺血性脑卒中和中血管闭塞患者进行血栓清除术与溶栓和血栓清除术联合治疗的评估。

背景静脉溶栓（IVT）联合机械取栓（MT）可能对中血管闭塞患者有临床益处。目的探讨在急性缺血性卒中（AIS）和中血管闭塞患者中，机械溶栓联合静脉溶栓与单纯机械溶栓的疗效是否不同。材料和方法这项回顾性研究纳入了在北美、亚洲和欧洲 37 个学术中心接受 MT 或 MT 联合 IVT 治疗的 AIS 和中血管闭塞的连续成年患者。数据收集时间为 2017 年 9 月至 2021 年 7 月。为减少混杂因素，进行了倾向评分匹配。进行了单变量和多变量逻辑回归分析，以检验增加 IVT 治疗与不同功能和安全性结果之间的关联。结果经过倾向评分匹配后，670 名患者（中位年龄 75 岁 [IQR，64-82 岁]；356 名女性）被纳入分析；其中 335 人单独接受了 MT 治疗，335 人接受了 MT 加 IVT 治疗。MT 组从开始到穿刺的中位时间（350 分钟 vs 210 分钟，P < .001）和从开始到再通畅的中位时间（397 分钟 vs 273 分钟，P < .001）分别高于 MT 联合 IVT 组。在单变量回归分析中，加用 IVT 与改良 Rankin 量表（mRS）0-2 分的几率更高相关（几率比 [OR]，1.44；95% CI：1.06，1.96；P = .019）；但在多变量分析中未观察到这种关联（OR，1.37；95% CI：0.99，1.89；P = .054）。在多变量分析中，增加 IVT 也没有证据表明与首通效应几率（OR，1.27；95% CI：0.9，1.79；P = .17）、脑梗塞溶栓治疗 2b-3 级（OR，1.64；95% CI：0.99，2.73；P = .055）、mRS 评分 0-1（OR，1.27；95% CI：0.91，1.76；P = .16）、死亡率（OR，0.78；95% CI：0.49，1.24；P = .29）或颅内出血（OR，1.25；95% CI：0.88，1.76；P = .21）。结论对于因远端和中血管闭塞导致的 AIS 患者，辅助 IVT 可能不会比 MT 更有效。© RSNA, 2024 这篇文章有补充材料。另请参阅本期 Wojak 的社论。

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来源期刊

Radiology 医学-核医学

CiteScore

35.20

自引率

3.00%

发文量

596

审稿时长

3.6 months

期刊介绍： Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.