摘要

OBJECTIVE:The substantial clinical improvement in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT), combined with the poor response of proximal intracranial occlusions to intravenous thrombolysis (IVT), led to questions regarding the utility of bridging therapy (BT; IVT followed by MT) compared to direct mechanical thrombectomy (dMT) for AIS patients with large vessel occlusion (LVO).
METHODS:We aimed to investigate the comparative safety and efficacy of BT and dMT in AIS patients. We included all observational studies and post hoc analyses from randomized controlled clinical trials that provided data on the outcomes of AIS patients with LVO stratified by IVT treatment status prior to MT.
RESULTS:We identified 38 eligible observational studies (11,798 LVO patients, mean age = 68 years, 56% treated with BT). In unadjusted analyses, BT was associated with a higher likelihood of 3-month functional independence (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.32-1.76), 3-month functional improvement (common OR [cOR] for 1-point decrease in modified Rankin Scale score = 1.52, 95% CI = 1.18-1.97), early neurological improvement (OR = 1.21, 95% CI = 1.83-1.76), successful recanalization (OR = 1.22, 95% CI = 1.02-1.46), and successful recanalization with ≤2 device passes (OR = 2.28, 95% CI = 1.43-3.64) compared to dMT. BT was also related to a lower likelihood of 3-month mortality (OR = 0.64, 95% CI = 0.57-0.73). In the adjusted analyses, BT was independently associated with a higher likelihood of 3-month functional independence (adjusted OR = 1.55, 95% CI = 1.26-1.91) and lower odds of 3-month mortality (adjusted OR = 0.80, 95% CI = 0.66-0.97) compared to dMT. The two groups did not differ in functional improvement (adjusted cOR = 1.24, 95% CI = 0.89-1.74) or symptomatic intracranial hemorrhage (adjusted OR = 0.87, 95% CI = 0.61-1.25).
INTERPRETATION:BT appears to be associated with improved functional independence without evidence for safety concerns, compared to dMT, for AIS patients with LVO. ANN NEUROL 2019;86:395-406.

译文

目的: 机械取栓术 (MT) 治疗的急性缺血性中风 (AIS) 患者的实质性临床改善,以及近端颅内闭塞对静脉溶栓 (IVT) 的不良反应, 导致了关于桥接疗法 (BT; IVT 之后是 MT) 与直接机械取栓术 (dMT) 相比的问题对于大血管闭塞 (LVO) 的 AIS 患者。
方法: 我们旨在研究 BT 和 dMT 在 AIS 患者中的比较安全性和有效性。我们包括了来自随机对照临床试验的所有观察性研究和事后分析,这些研究提供了在 MT 之前根据 IVT 治疗状态分层的患有 LVO 的 AIS 患者的结果数据。
结果: 我们确定了 38 项合格的观察性研究 (11,798 名 LVO 患者,平均年龄 = 68 岁,56% 名接受 BT 治疗)。在未经调整的分析中,BT 与 3 个月功能独立性的较高可能性相关 (比值比 [OR] = 1.52,95% 置信区间 [CI] = 1.32-1.76), 3 个月的功能改善 (普通或 [cOR] 在改良的 Rankin 量表得分 = 1.52,95% CI = 1.18-1.97 中减少 1 分),早期神经功能改善 (OR = 1.21,95% CI = 1.83-1.76),成功再通 (OR = 1.22,95% CI = 1.02-1.46), 与 dMT 相比,设备通过 (OR = 2.28,95% CI = 1.43-3.64) ≤ 2 次的成功再通。BT 也与 3 个月死亡率较低的可能性有关 (OR = 0.64,95% CI = 0.57-0.73)。在调整后的分析中,BT 与 3 个月功能独立性的较高可能性独立相关 (调整后 OR = 1.55,95% CI = 1.26-1.91) 与 dMT 相比,3 个月死亡率 (调整后 OR = 0.80,95% CI = 0.66-0.97) 的几率更低。两组在功能改善 (校正 cOR = 1.24,95% CI = 0.89-1.74) 或症状性颅内出血 (校正 or = 0.87,95% CI = 0.61-1.25) 方面没有差异。
解释: 对于 LVO 的 AIS 患者,与 dMT 相比,BT 似乎与功能独立性的改善相关,而没有安全问题的证据。ANN NEUROL 2019; 86: 395-406。

Thrombectomy

神经 手术方法 治疗方法
概述  :  

血栓取出术主要用于去除血管中的血栓,是一种新颖的治疗方法。除了外科手术直接取出血栓外,还可在患者血管中插入导管,通过导管清除血栓来恢复血供。清除血栓后可能会置入支架或过滤器,在此过程中可能用到药物来防止进一步的凝血。主要包括外伤手术切开血管取出血栓,也可使用球囊导管取出栓子,后者可缩短手术时间,创伤较小。四肢动脉取栓适应症:原则上动脉栓塞除肢体已发生严重坏疽者或栓塞的动脉支较小,远端已建立良好的侧支,不影响血供者外,只要患者全身情况许可均应积极施行取栓术。发病时间的长短与栓子摘取术效果有密切

thrombectomy   [θrɔm'bektəmi]

        n. 血栓取出术

同根词     thrombosis n. 血栓形成

        The clinical application of catheter thrombectomy and catheter-directed thrombolysis in acute lower limb deep vein thrombosis. 导管取栓及导管接触性溶栓在急性下肢深静脉血栓中的临床应用

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