Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad-Mahdi Sowlat, Atakan Orscelik, Noah L A Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Alejandro M Spiotta, Michael R Levitt, Nitin Goyal
{"title":"对接受机械血栓切除术的脑卒中患者进行静脉和动脉内联合溶栓与单纯静脉溶栓的比较:倾向匹配分析。","authors":"Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad-Mahdi Sowlat, Atakan Orscelik, Noah L A Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Alejandro M Spiotta, Michael R Levitt, Nitin Goyal","doi":"10.1136/jnis-2024-021975","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.</p><p><strong>Methods: </strong>STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.</p><p><strong>Results: </strong>A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).</p><p><strong>Conclusion: </strong>The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5000,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis.\",\"authors\":\"Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad-Mahdi Sowlat, Atakan Orscelik, Noah L A Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Alejandro M Spiotta, Michael R Levitt, Nitin Goyal\",\"doi\":\"10.1136/jnis-2024-021975\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.</p><p><strong>Methods: </strong>STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.</p><p><strong>Results: </strong>A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).</p><p><strong>Conclusion: </strong>The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.</p>\",\"PeriodicalId\":16411,\"journal\":{\"name\":\"Journal of NeuroInterventional Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2024-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of NeuroInterventional Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/jnis-2024-021975\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NEUROIMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2024-021975","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}
引用次数: 0
摘要
背景:有学者研究了静脉(IVT)或动脉内(IAT)溶栓联合机械取栓(MT)治疗大血管闭塞导致的急性缺血性卒中(AIS-LVO)。然而,与 MT 前仅接受 IVT 相比,同时接受 IVT 和 IAT 的患者数据有限:我们利用了 2013 年至 2023 年的 STAR 数据。我们对两组患者进行了倾向得分匹配。主要结果是症状性颅内出血(sICH)和90天改良Rankin量表(mRS)0-2分。次要结果包括成功再通(脑梗塞改良治疗(mTICI)≥2B、≥2C)、早期神经功能改善、任何颅内出血(ICH)和90天死亡率:共纳入 2454 例 AIS-LVO 患者。倾向匹配结果显示,每组均有190名匹配良好的患者。两组患者的 ICH 或 sICH 均无明显差异(几率比(OR):0.80,95% 置信区间(CI)0.51-1.24,P=0.37;OR:0.60,95% CI 0.29 至 1.24,P=0.21)。MT+IVT + IAT的再通成功率和早期神经功能改善率(ENI)明显较低,两组间的mRS 0-1和死亡率无明显差异。然而,与mTICI≤2B的MT+IVT组患者相比,MT+IVT+IAT组患者的良好功能预后率(90天mRS 0-1)更高(OR:2.18,95% CI 1.05至3.99,P=0.04):结论:在接受MT治疗的AIS-LVO患者中联合使用IAT和IVT溶栓是安全的。虽然 MT+IVT+ IAT 组的再通率和早期神经功能改善率较低,但该组患者的长期功能预后良好,这表明 IAT 有可能带来延迟获益。
Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis.
Background: A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.
Methods: STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.
Results: A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).
Conclusion: The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.
期刊介绍:
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.