Outcome After Thrombectomy and Intravenous Thrombolysis in Patients With Acute Ischemic Stroke A Prospective Observational Study

被引：93

作者：

Minnerup, Jens ^{[1
]}

Wersching, Heike ^{[2
]}

Teuber, Anja ^{[2
]}

Wellmann, Jurgen ^{[2
]}

Eyding, Jens ^{[3
]}

Weber, Ralph ^{[5
]}

Reimann, Gernot ^{[6
]}

Weber, Werner ^{[4
]}

Krause, Lars Udo ^{[7
]}

Kurth, Tobias ^{[8
,9
]}

Berger, Klaus ^{[2
]}

机构：

[1] Univ Munster, Dept Neurol, Albert Schweitzer Campus 1, D-48149 Munster, Germany

[2] Univ Munster, Inst Epidemiol & Social Med, Albert Schweitzer Campus 1, D-48149 Munster, Germany

[3] Ruhr Univ Bochum, Univ Hosp Knappschaftskrankenhaus Bochum, Dept Neurol, Univ Str 150, Bochum, Germany

[4] Ruhr Univ Bochum, Univ Hosp Knappschaftskrankenhaus Bochum, Inst Radiol Neuroradiol & Nucl Med, Univ Str 150, Bochum, Germany

[5] Alfried Krupp Hosp, Dept Neurol, Essen, Germany

[6] Stadt Klinikum Dortmund, Dept Neurol, Dortmund, Germany

[7] Klinikum Osnabruck, Dept Neurol, Osnabruck, Germany

[8] INSERM, Res Ctr Epidemiol & Biostat, Team Neuroepidemiol, Bordeaux, France

[9] Univ Bordeaux, Coll Hlth Sci, Bordeaux, France

来源：

STROKE | 2016年 / 47卷 / 06期

关键词：

informed consent; mortality; reperfusion; stroke; thrombectomy; TISSUE-PLASMINOGEN ACTIVATOR; ENDOVASCULAR TREATMENT; T-PA; EXPERIENCE; THERAPY; TRIAL; TIME;

D O I：

10.1161/STROKEAHA.116.012619

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-In patients with ischemic stroke, randomized trials showed a better functional outcome after endovascular therapy with new-generation thrombectomy devices compared with medical treatment, including intravenous thrombolysis. However, effects on mortality and the generalizability of results to routine clinical practice are uncertain. Methods-In a prospective observational register-based study patients with ischemic stroke treated either with thrombectomy, intravenous thrombolysis, or their combination were included. Primary outcome was the modified Rankin scale score (0 [no symptoms] to 6 [death]) at 3 months. Ordinal logistic regression was used to estimate the common odds ratio as treatment effects (shift analysis). Propensity score matching was applied to compare patients treated either with intravenous thrombolysis alone or with intravenous thrombolysis plus thrombectomy. Results-Among 2650 recruited patients, 1543 received intravenous thrombolysis, 504 underwent thrombectomy, and 603 received intravenous thrombolysis in combination with thrombectomy. Later time-to-treatment was associated with worse outcomes among patients treated with thrombectomy plus thrombolysis. In 241 pairs of propensity score-matched patients with a proximal intracranial occlusion, thrombectomy plus thrombolysis was associated with improved functional outcome (common odds ratio, 1.84; 95% confidence interval, 1.32-2.57), and reduced mortality (15% versus 33%; P < 0.0001) compared with intravenous thrombolysis alone. Results were similar in various sensitivity analyses accounting for missing outcome data and different analytic methods. Conclusions-Results from this large prospective registry show that also in routine clinical care thrombectomy plus thrombolysis compared with thrombolysis alone improved functional outcome and reduced mortality in patients with ischemic stroke. Earlier treatment was associated with better outcomes.

引用

页码：1584 / U442

页数：20

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