- 作者：Fabrizio Sallustio ; Giacomo Koch ; Silvia Di Legge ; Costanza Rossi ; Barbara Rizzato ; Simone Napolitano ; Domenico Sam脿 ; Natale Arn貌 ; Angela Giordano ; Domenicantonio Tropepi ; Giulia Misaggi ; Marina Diomedi ; Costantino Del Giudice ; Alessio Spinelli ; Sebastiano Fabiano ; Matteo Stefanini ; Daniel Konda ; Carlo Andrea Reale ; Enrico Pampana ; Giovanni Simonetti ; et al.
- 关键词：Acute ischemic stroke ; intravenous thrombolysis ; large intracranial vessel occlusion ; neurothrombectomy
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：November, 2013
- 年：2013
- 卷：22
- 期：8
- 页码：e323-e331
- 全文大小：117 K
Background
Severely impaired patients with persisting intracranial occlusion despite standard treatment with intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) or presenting beyond the therapeutic window for IV rtPA may be candidates for interventional neurothrombectomy (NT). The safety and efficacy of NT by the Penumbra System (PS) were compared with standard IV rtPA treatment in patients with severe acute ischemic stroke (AIS) caused by large intracranial vessel occlusion in the anterior circulation.Methods
Consecutive AIS patients underwent a predefined treatment algorithm based on arrival time, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on computed tomographic angiography (CTA). NT was performed either after a standard dose of IV rtPA (bridging therapy [BT]) or as single treatment (stand-alone NT [SAT]). Rates of recanalization, symptomatic intracranial bleeding (SIB), mortality, and functional outcome in NT patients were compared with a historical cohort of IV rtPA treated patients (i.e., controls). Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score 鈮?.
Results
Forty-six AIS patients were treated with NT and 51 with IV rtPA. The 2 groups did not differ with regard to demographics, onset NIHSS score (18.5 卤 4 v 17 卤 5; P = .06), or site of intracranial occlusion. Onset-to-treatment time in the NT and IV rtPA groups was 230 minutes (卤78) and 176.5 (卤44) minutes, respectively (P = .001). NT patients had significantly higher percentages of major improvement (鈮?聽points NIHSS score change at 24 hours; 26% v 10%; P = .03) and partial/complete recanalization (93.5% v 45%; P < .0001) compared to controls. Treatment by either SAT or BT similarly improved the chance of early recanalization and early clinical improvement. No significant differences were observed in the rate of SIB (11% v 6%), 3-month mortality (24% v 25%), or favorable outcome (40% v 35%) between NT and IV rtPA patients.
Conclusions
Despite significantly delayed time of intervention, NT patients had higher rates of recanalization and early major improvement, with no differences in symptomatic intracranial hemorrhages. Early NIHSS score improvement did not translate into better 3-month mortality or outcome. NT seems a safe and effective adjuvant treatment strategy for selected patients with severe AIS secondary to large intracranial vessel occlusion in the anterior circulation.