Impact of Thrombus Length on Outcomes After Intra-Arterial Aspiration Thrombectomy in the THERAPY Trial

被引：43

作者：

Yoo, Albert J. ^{[1
]}

Khatri, Pooja ^{[2
]}

Mocco, J. ^{[3
]}

Zaidat, Osama O. ^{[4
]}

Gupta, Rishi ^{[5
]}

Frei, Donald ^{[6
]}

Lopes, Demetrius ^{[7
]}

Shownkeen, Harish ^{[8
]}

Berkhemer, Olvert A. ^{[9
,10
,11
]}

Meyer, Denise ^{[12
]}

Hak, Susana S. ^{[12
]}

Kuo, Sophia S. ^{[12
]}

Buell, Hope ^{[12
]}

Bose, Arani ^{[12
]}

Sit, Siu Po ^{[12
]}

von Kummer, Rdiger ^{[13
]}

机构：

[1] Texas Stroke Inst, Dallas, TX USA

[2] Univ Cincinnati, Cincinnati, OH 45221 USA

[3] Mt Sinai Hlth Syst, New York, NY USA

[4] St Vincent Mercy Med Ctr, Toledo, OH USA

[5] WellStar Hlth Syst, Marietta, GA USA

[6] Swedish Med Ctr, Englewood, CO USA

[7] Rush Univ, Chicago, IL 60612 USA

[8] Cent DuPage Hosp, Winfield, IL USA

[9] Amsterdam Med Ctr, Amsterdam, Netherlands

[10] Erasmus MC Univ, Med Ctr, Acad Med Ctr Amsterdam, Rotterdam, Netherlands

[11] Maastricht Univ, Med Ctr, Maastricht, Netherlands

[12] Penumbra Inc, Alameda, CA USA

[13] Univ Klinikum Carl Gustav Carus, Dresden, Germany

来源：

STROKE | 2017年 / 48卷 / 07期

关键词：

middle cerebral artery; stroke; thrombectomy; thrombosis; ACUTE ISCHEMIC-STROKE; ENDOVASCULAR TREATMENT; PLASMINOGEN-ACTIVATOR; EARLY RECANALIZATION;

D O I：

10.1161/STROKEAHA.116.016253

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-Increasing thrombus length (TL) impedes recanalization after intravenous (IV) thrombolysis. We sought to determine whether the clinical benefit of aspiration thrombectomy relative to IV r-tPA (recombinant tissuetype plasminogen activator) may be greater at longer TL. Methods-THERAPY was a randomized trial of aspiration thrombectomy plus IV r-tPA versus IV r-tPA alone in largevessel stroke patients with prospective TL measurement >= 8 mm. In this post hoc study, we evaluated the association of TL with trial end points and potential endovascular treatment effect, using univariate, multivariable, and multiplicative interaction analyses. Results-TL data were available for all 108 patients (28% internal carotid artery, 62% M1, and 10% M2). Median TL was 14.0 mm (interquartile range, 9.7-19.5 mm). Longer TL was associated with worse outcome (90-day modified Rankin Scale score: odds ratio, 1.24 per 5-mm TL increment; 95% confidence interval, 1.04-1.52; P=0.02), even after adjusting for key outcome predictors (adjusted P=0.004). Longer TL was also associated with more serious adverse events (adjusted P=0.01), more symptomatic hemorrhages (adjusted P=0.03), and increased mortality (adjusted P=0.01). No significant relationship was observed between TL and angiographic reperfusion (modified thrombolysis in cerebral ischemia 2b-3), but greater TL was associated with longer endovascular procedural times (rho=0.36; P=0.045). Increasing TL was associated with greater aspiration thrombectomy treatment effect (interaction term P=0.03). This might be related to a potentially stronger adverse effect of increasing TL on 90-day modified Rankin Scale for patients treated with IV r-tPA (rho=0.39; P=0.01) compared with intra-arterial therapy (rho=0.20; P=0.165). Conclusions-Ischemic stroke patients with longer symptomatic thrombi have worse 90-day clinical outcomes but may have a greater relative benefit of aspiration thrombectomy over IV r-tPA alone.

引用

页码：1895 / +

页数：11

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