发病6h内的急性大血管闭塞性脑卒中直接机械取栓与桥接治疗的对比

The clinical analysis of direct mechanical thrombectomy and intravenous thrombolysis bridging mechanical thrombectomy therapy in acute large vessel occlusion stroke within 6h of onset

目的 探讨发病6 h内的急性大血管闭塞性脑卒中患者行直接机械取栓治疗与静脉溶栓桥接机械取栓治疗的有效性和安全性。方法 回顾性分析2019年11月~2020年12月我院收治的发病6 h内的急性大血管闭塞性脑卒中患者105例的临床资料,根据治疗方式的不同分为直接机械取栓组(直取组,n=64)和静脉溶栓桥接机械取栓组(桥接组,n=41)。比较两组患者的基线资料、安全性和有效性指标(颅内出血发生率、死亡率、术后成功再灌注率、术后24 h NIHSS评分及90 d良好功能结局率);亚组研究按溶栓剂不同将桥接组患者分为阿替普酶桥接治疗组和尿激酶桥接治疗组,并分析两组间的安全性和有效性指标。结果 两组患者基线资料、诊治情况等比较差异无统计学意义(P>0.05);两组患者在成功再灌注率、24 h NIHSS评分、颅内出血发生率、死亡率及90 d良好功能结局率等方面比较差异均无统计学意义(P>0.05);同时亚组分析显示,溶栓剂并不影响桥接治疗的主要及次要结局(P>0.05)。结论 静脉溶栓桥接机械取栓治疗和直接机械取栓治疗对发病6 h内的急性大血管闭塞性脑卒中的安全性和疗效一致,且尿激酶桥接治疗和阿替普酶桥接治疗的安全性和预后相当(P>0.05)。

Objective To compare the efficacy and safety of direct mechanical thrombectomy(dMT) and intravenous thrombolysis bridging mechanical thrombectomy therapy(BT) in acute large vessel occlusion stroke within 6 h of onset. Methods We retrospectively analyzed the clinical data of patients with acute large vessel occlusion stroke in our hospital from November 2019 to December 2020. The patients were divided into dMT group and BT group according to treated with different therapy. The clinical baseline data, safety and effectiveness indicators(incidence of intracranial hemorrhage, mortality, successful reperfusion, NIHSS scores at 24 h, favorable functional outcome at 90 d) were compared between the two group. In the sub-studies, the patients in the bridging group were divided into the alteplase bridging treatment group and the urokinase bridging treatment group according to the different thrombolytic agent, and the safety and effectiveness indexes between the two groups were analyzed. Results Baseline characteristics did not differ between the dMT and BT group(P>0.05). The successful reperfusion rate, NIHSS scores at 24 h, incidence of intracranial hemorrhage, mortality, and favorable functional outcome at 90 d were not significantly different between the two group(P>0.05). meanwhile our subgroup analysis showed that thrombolytic agents did not affect the primary and secondary outcomes of bridging therapy(P>0.05). Conclusion The efficacy and safety of dMT and BT are similar for acute large vessel occlusion stroke within 6 h of onset, there were not different in the safety and prognosis between urokinase bridging therapy and alteplase bridging therapy(P>0.05).