Efficacy of different vascular recanalization methods for acute ischemic stroke / 中华全科医师杂志

ABSTRACT

Objective To assess the efficacy of different vascular recanalization methods for acute ischemic stroke (AIS). Methods The clinical data of AIS patients receiving vascular recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively analyzed. Among 141 AIS patients, 64 received intravenous thrombolysis (IVT group), 57 received endovascular treatment (EVT group) and 20 received intravenous thrombolysis and endovascular treatment (IVT+EVT group). The efficacy and safety of therapy were compared among three groups. Results There were no significant differences in the risk factors of cerebrovascular diseases among 3 groups (P>0.05). The National Institute of Health Stroke Scale(NIHSS) scores [M(Q1,Q3)] of patients in the IVT group, EVT group and IVT+EVT group were 9.5 (6.0, 15.0), 15.0 (9.0,19.0) and 14.0(8.3,17.0), respectively (Z=7.19, P<0.05). The time from onset to treatment in the three groups was 205.0 (156.3, 254.3) min, 260.0 (170.0, 401.5) min, and 137.5 (90.3, 137.5) min, respectively (Z=22.83, P<0.01). The proportion of large arteries occlusion was lower in IVT group (32.8％, 21/64), compared with EVT group (86.0％, 49/57) and IVT+EVT group (95.0％, 19/20) (χ2=46.77, P<0.01). The proportion of symptomatic intracranial hemorrhage in IVT group was lower than EVT and IVT+EVT group [1.6％ (1/64) vs. 15.8％ (9/57) and 10.0％ (2/20), χ2=8.36, P<0.05]. The favorable outcome rates in IVT, EVT and IVT+EVT groups at the 90 d (mRS score≤2) were 57.8％ (37/64), 45.6％ (26/57) and 40.0％(8/20), respectively (χ2=2.79, P=0.24). The fatality rates in three groups were 10.9％ (7/64), 19.3％ (11/57) and 5.0％ (1/20), respectively (χ2=2.84, P=0.21). Conclusions Intravenous thrombolysis, endovascular therapy and bridging therapy have similar effects on the prognosis of AIS. Mild severity of AIS patients are more likely to benefit from intravenous thrombolysis. AIS patients with severe disease are usually combined with large artery occlusion, and more suitable for endovascular treatment and bridging treatment.