中国卒中杂志2019，Vol.14Issue(4)：309-316,8.DOI:10.3969/j.issn.1673-5765.2019.04.003
后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究
Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke
摘要
Abstract
Objective To compare the clinical outcome of endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone for acute posterior circulation stroke. Methods Two cohorts of consecutive patients from Beijing Tian Tan Hospital from March 2012 to November 2016 were selected: EVT group were patients who underwent stent-retriever thrombectomy without IVT for acute vertebrobasilar occlusion; IVT group were patients with acute posterior circulation stroke treated with rt-PA IVT alone. The efficacy and safety outcome of the two groups were compared. The two groups were matched for age, sex, baseline NIHSS score, onset-to-treatment time and ischemic stroke subtype at 1:1 ratio. Ischemic stroke subtype was classified according to TOAST criteria. The baseline NIHSS score after matching was ≥10. The primary outcome was mRS score at 90 days, and the safety outcome was intracranial hemorrhage within 24 hours and all-cause mortality at 90 days. Results A total of 328 patients were included, with 69 cases in EVT group and 259 in IVT group. There were 55 patients in two matched groups. Stroke subtype in two groups were both mainly large artery atherosclerosis (LAA) stroke, with 63 cases (91.3%) in EVT group and 164 cases (63.3%) in IVT group. The rate of mRS≤1 (30.9% vs 38.2%, adjusted OR 0.724, 95% CI 0.329-1.595, P=0.423) and mRS≤2 at 90 days (38.2% vs 50.9%, adjusted OR 0.596, 95% CI 0.279-1.272, P=0.181) were both lower in EVT group than that in IVT group, but the differences were not statistically significant. There were also no significant differences in all-cause mortality at 90 days and symptomatic ICH within 24 hours between the two groups. Conclusions In acute posterior circulation stroke caused by large vessel occlusion, the outcome after intravenous thrombolysis alone or endovascular revascularization appeared similar. Further randomized clinical trials are needed to confirm this finding.关键词
急性缺血性卒中/后循环/大血管闭塞/血管内治疗/静脉溶栓Key words
Acute ischemic stroke/Posterior circulation/Large vessel occlusion/Endovascular treatment/Intravenous thrombolysis引用本文复制引用
LUO Gang,HUO XiaoChuan,WANG Bo,JIA BaiXue,LI XiaoQing,XU XiaoTong,MIAO ZhongRong,HUANG YiNuo,MO DaPeng,SUN ZhongLiang,MA Ning,GAO Feng,SONG LiGang,SUN Xuan,LIU Lian..后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究[J].中国卒中杂志,2019,14(4):309-316,8.基金项目
科技部国家重点研发计划项目(2016YFC1301500 （）
2018YFC1312801) （）
