Endovascular thrombectomy can be beneficial to acute ischemic stroke patients with large infarcts

被引：22

作者：

Jiang, Shaowei ^{[1
]}

Peng, Ya ^{[3
]}

Jing, Chao-hui ^{[2
]}

Fei, Ai-hua ^{[1
]}

Wang, Hai-rong ^{[1
]}

Gao, Cheng-jin ^{[1
]}

Chen, Miao ^{[1
]}

Li, Yi ^{[2
]}

Pan, Shuming ^{[1
]}

机构：

[1] Shanghai Jiao Tong Univ, Xinhua Hosp, Dept Emergency, Sch Med, Shanghai, Peoples R China

[2] Shanghai Jiao Tong Univ, Xinhua Hosp, Dept Neurosurg, Sch Med, Shanghai, Peoples R China

[3] Soochow Univ, Peoples Hosp Changzhou 1, Cerebral Vasc Dis Ctr, Changzhou, Peoples R China

来源：

JOURNAL OF NEUROSURGERY | 2019年 / 130卷 / 04期

基金：

中国国家自然科学基金;

关键词：

acute ischemic stroke; thrombectomy; ASPECTS; large infarcts; vascular disorders; thrombolysis; TISSUE-PLASMINOGEN ACTIVATOR; EARLY CT SCORE; INTRAVENOUS THROMBOLYSIS; MECHANICAL THROMBECTOMY; INTRAARTERIAL TREATMENT; SOLITAIRE STENT; THERAPY; TRIAL; METAANALYSIS; RETRIEVER;

D O I：

10.3171/2017.11.JNS171297

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE This study aimed to assess whether patients with acute ischemic stroke (AIS) and large infarct lesions benefit from reperfusion management. To determine the efficacy of different recanalization managements on AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) < 6, the authors retrospectively analyzed hospitalized patients with AIS. METHODS Eighty-nine patients with AIS and ASPECTS < 6 were screened from 13,285 hospitalized patients treated by thrombolysis, thrombectomy, or conventional care in two stroke medical centers. Logistic regression or Fisher's exact test was performed for comparison of the outcome and risk events between patients treated by thrombectomy (or thrombolysis) and conventional care. The modified Rankin Scale (mRS) score was used to assess the major clinical outcome of patients 3 months after disease onset. Disease outcome was also examined by analyzing symptom improvement at discharge. In particular, mortality and symptomatic intracranial hemorrhage (sICH) were evaluated as risk factors. RESULTS This study included 21 patients who received thrombolysis, 36 patients receiving thrombectomy, and 32 patients receiving conventional treatment. Among these 3 treatments, only the thrombectomy group clearly showed the most encouraging clinical outcome (mRS score 0-2; p < 0.05, Fisher's exact test) and marked improvement (OR 25.84, 95% CI 2.44-273.59) compared with conventional treatment. It is noteworthy that the mortality rate of the thrombectomy and thrombolysis group was similar to that of the conventional group, and thrombectomy and thrombolysis increased the risk of sICH in comparison with conventional care (p < 0.05, Fisher's exact test). CONCLUSIONS Patients with AIS and ASPECTS < 6 definitely benefited from thrombectomy with higher sICH risk, whereas thrombolysis management showed similar efficacy to the control group.

引用

页码：1383 / 1390

页数：8

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