Efficacy analysis of intravenous thrombolysis bridging intra-arterial thrombectomy for the treatment of acute intracranial large-vessel occlusion / 中国脑血管病杂志

ABSTRACT

Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.