Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke

doi:10.3969/j.issn.1673-5765.2019.04.003

Abstract

Abstract:

Objective To compare the clinical outcome of endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone for acute posterior circulation stroke. Methods Two cohorts of consecutive patients from Beijing Tian Tan Hospital from March 2012 to November 2016 were selected: EVT group were patients who underwent stent-retriever thrombectomy without IVT for acute vertebrobasilar occlusion; IVT group were patients with acute posterior circulation stroke treated with rt-PA IVT alone. The efficacy and safety outcome of the two groups were compared. The two groups were matched for age, sex, baseline NIHSS score, onset-to-treatment time and ischemic stroke subtype at 1:1 ratio. Ischemic stroke subtype was classified according to TOAST criteria. The baseline NIHSS score after matching was ≥10. The primary outcome was mRS score at 90 days, and the safety outcome was intracranial hemorrhage within 24 hours and all-cause mortality at 90 days. Results A total of 328 patients were included, with 69 cases in EVT group and 259 in IVT group.There were 55 patients in two matched groups. Stroke subtype in two groups were both mainly large artery atherosclerosis (LAA) stroke, with 63 cases (91.3%) in EVT group and 164 cases (63.3%) in IVT group. The rate of mRS ≤1 (30.9% vs 38.2%, adjusted OR 0.724, 95%CI 0.329-1.595, P =0.423) and mRS ≤2 at 90 days (38.2% vs 50.9%, adjusted OR 0.596, 95%CI 0.279-1.272, P =0.181) were both lower in EVT group than that in IVT group, but the differences were not statistically significant. There were also no significant differences in all-cause mortality at 90 days and symptomatic ICH within 24 hours between the two groups. Conclusions In acute posterior circulation stroke caused by large vessel occlusion, the outcome after intravenous thrombolysis alone or endovascular revascularization appeared similar. Further randomized clinical trials are needed to confirm this finding.

Key words: Acute ischemic stroke; Posterior circulation; Large vessel occlusion; Endovascular treatment; Intravenous thrombolysis

摘要：

目的比较后循环大血管闭塞致急性缺血性卒中患者接受血管内治疗（endovascular treatment，EVT）与单纯静脉溶栓（intravenous thrombolysis，IVT）治疗后的临床结局。方法纳入2012年3月-2016年11月期间在北京天坛医院行EVT与IVT治疗的后循环大血管闭塞所致急性缺血性卒中患者，以1∶1比例匹配两组的年龄、性别、基线NIHSS评分、发病至治疗时间及卒中亚型（TOAST分型），匹配患者的NIHSS评分≥10分。主要疗效结局为治疗后90 d的mRS评分，安全性结局为 24 h ICH及90 d全因死亡率。结果共纳入328例后循环急性缺血性卒中患者，其中EVT组69例，IVT组259例，匹配后两组基线数据相似，每组各55例。各卒中亚型比例在两组均有显著性差异（所有P <0.001），两组均以大动脉粥样硬化型为主，其中EVT组63例（91.3%），IVT组164例（63.3%）。临床疗效结局显示匹配后EVT组90 d mRS评分≤1分比例（30.9% vs 38.2%，校正OR 0.724，95%CI 0.329～1.595，P =0.423）及mRS评分≤2 分比例（38.2% vs 50.9%，校正OR 0.596，95%CI 0.279～1.272，P =0.181）均低于IVT组，但差异均无统计学意义。安全性结局方面，24 h症状性脑出血及治疗后90 d全因死亡率，两组比较差异也无统计学意义。结论对于后循环大血管闭塞所致急性缺血性卒中患者行EVT治疗和单纯IVT治疗，在疗效及安全性结局方面均无显著性差异。

关键词: 急性缺血性卒中; 后循环; 大血管闭塞; 血管内治疗; 静脉溶栓

LUO Gang, HUANG Yi-Nuo, MO Da-Peng, SUN Zhong-Liang, MA Ning, GAO Feng, SONG Li-Gang, SUN Xuan, LIU Lian, HUO Xiao-Chuan, WANG Bo, JIA Bai-Xue, LI Xiao-Qing, XU Xiao-Tong, MIAO Zhong-Rong. Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke[J]. Chinese Journal of Stroke, 2019, 14(04): 309-316.

罗岗, 黄祎诺, 莫大鹏, 孙忠良, 马宁, 高峰, 宋立刚, 孙瑄, 刘恋, 霍晓川, 王博, 贾白雪, 李晓青, 徐晓彤, 缪中荣. 后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究[J]. 中国卒中杂志, 2019, 14(04): 309-316.

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