Endovascular Treatment versus Sonothrombolysis for Acute Ischemic Stroke

被引：7

作者：

Reinhard, Matthias ^{[1
]}

Taschner, Christian A. ^{[2
]}

Hoersch, Nicole ^{[1
]}

Allignol, Arthur ^{[4
]}

Maurer, Christoph J. ^{[2
]}

Niesen, Wolf-Dirk ^{[1
]}

Lambeck, Johann ^{[1
]}

Wallesch, Claus W. ^{[5
]}

Urbach, Horst ^{[2
]}

Weiller, Cornelius ^{[1
]}

Schuchardt, Volker ^{[3
]}

Griesser-Leute, Hans-Joerg ^{[3
]}

机构：

[1] Univ Freiburg, Acad Teaching Hosp, Dept Neurol, D-79106 Freiburg, Germany

[2] Univ Freiburg, Acad Teaching Hosp, Univ Med Ctr Freiburg, Dept Neuroradiol, D-79106 Freiburg, Germany

[3] Univ Freiburg, Acad Teaching Hosp, Lahr Ettenheim Med Ctr, Dept Neurol, D-79106 Freiburg, Germany

[4] Univ Ulm, Dept Stat, D-89069 Ulm, Germany

[5] BDH Hosp Neurorehabil, Elzach, Germany

来源：

CEREBROVASCULAR DISEASES | 2015年 / 40卷 / 5-6期

关键词：

Acute ischemic stroke; Thrombolysis; Endovascular treatment; Sonothrombolysis; INTRAVENOUS THROMBOLYSIS; RECANALIZATION; INTRAARTERIAL; VALIDATION; DEVICE;

D O I：

10.1159/000439142

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Currently, there are 2 strategies to increase the effect of systemic thrombolysis with alteplase (rtPA) in acute major stroke: endovascular treatment via stent retrieval and ultrasound enhancement (sonothrombolysis). This study compares these 2 approaches in patients with proximal intracranial occlusion of the anterior circulation. Methods: Consecutive data on the treatment outcome of acute middle cerebral artery (M1) or carotid T occlusion were collected from 2 stroke centers: one center used rtPA plus endovascular stent retrieval as standard treatment and the other rtPA plus ultrasound (sonothrombolysis). The primary outcome was functional independence (modified Rankin scale (mRS) 0-2) after neurorehabilitation. Results: A total of 132 patients were assessed (n = 73 endovascular, n = 59 sonothrombolysis). The rate of functional independence was higher for endovascular treatment (adjusted OR 3.89 (95% CI 1.36-12.58)). Additionally, ordinal mRS analysis favored the endovascular strategy (adjusted common OR 1.70 (95% CI 0.88-3.31)). Subgroup analysis showed that endovascular treatment was superior for carotid T occlusion (adjusted common OR 5.61 (95% CI 1.60-20.93)), but not for middle cerebral artery occlusion (adjusted common OR 1.07 (95% CI 0.47-2.43)). Symptomatic intracerebral hemorrhage occurred in 3 patients from the endovascular group. Conclusions: This observational study suggests that endovascular treatment of acute major anterior circulation stroke is superior to sonothrombolysis in terms of functional outcome. This benefit seems to pertain primarily to patients with carotid T occlusion, whereas patients with M1 occlusion seem to profit in a similar way from both methods. (C) 2015 S. Karger AG, Basel

引用

页码：205 / 214

页数：10

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