rt-PA静脉溶栓对急性缺血性脑卒中机械取栓后血栓的影响

Effect of rt-PA intravenous thrombolysis on thrombi after mechanical thrombectomy in patients with acute ischemic stroke

目的:探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对急性缺血性脑卒中(AIS)患者机械取栓后血栓大小及成分的影响。方法:收集南京医科大学附属淮安第一医院神经内科自2018年6月至2022年6月收治的接受机械取栓的98例AIS患者进入研究,根据治疗方式分为桥接治疗组和单纯取栓组,比较2组患者一般资料、预后情况及血栓特征的差异。结果:2组患者年龄、性别、既往史、基线评分、血管闭塞部位、血管闭塞类型、TOAST病因学分型、时间节点、机械取栓次数、取栓技术、血管成功再通情况、90 d预后等方面差异均无统计学意义(P>0.05)。与单纯取栓组患者血栓比较,桥接治疗组患者的血栓面积明显减小[37(22,78)mm^(2)vs.27(14,62)mm^(2)],血栓中的主要病理成分面积明显减小[红细胞:16.1(9.0,37.4)mm^(2)vs.11.8(6.1,22.1)mm^(2),纤维蛋白/血小板:19.5(9.5,26.4)mm^(2)vs.10.7(5.0,22.8)mm^(2),白细胞:4.0(2.2,8.0)mm^(2)vs.2.4(1.4,5.7)mm^(2)],差异均有统计学意义(P<0.05);但2组患者血栓主要病理成分的面积百分比差异无统计学意义(P>0.05)。结论:rt-PA静脉溶栓可显著减少AIS患者机械取栓后血栓面积及主要病理成分面积,但不改变血栓主要病理成分的占比。

Objective To investigate the effect of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)on sizes and components of thrombi in patients with acute ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods Ninety-eight AIS patients accepted MT in Department of Neurology,Huaian First Hospital Affiliated to Nanjing Medical University from June 2018 to June 2022 were enrolled;they were divided into bridging therapy group and direct thrombectomy group according to the treatments.Baseline data,prognoses and thrombus features between the 2 groups were compared.Results No significant differences were observed between the 2 groups in terms of age,gender,previous medical history,baseline scores,sites and types of vascular occlusion,TOAST causative classifications,time frame,MT frequencies and techniques,successful recanalization,or prognoses 90 d after MT(P>0.05).Compared with the direct thrombectomy group,the bridging therapy group had significantly reduced thrombus area(37[22,78]mm^(2)vs.27[14,62]mm^(2))and areas of major pathological components[red blood cells:16.1([9.0,37.4]mm^(2)vs.11.8[6.1,22.1]mm^(2),fibrin/platelets:19.5[9.5,26.4]mm^(2)vs.10.7[5.0,22.8]mm^(2),white blood cells:4.0[2.2,8.0]mm^(2)vs.2.4[1.4,5.7]mm^(2),P<0.05);however,no significant differences in proportions of areas of major pathological components were noted between the 2 groups of patients(P>0.05).Conclusion The rt-PA intravenous thrombolysis can significantly reduce the thrombi volume and decrease the contents of major thrombus components in AIS patients after MT,but not change the proportions of major pathological components in thrombi.