دورية أكاديمية
أعرض في EDS

Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions.

التفاصيل البيبلوغرافية
العنوان: Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions.
المؤلفون: Katsanos AH; Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Malhotra K; Department of Neurology, West Virginia University-Charleston Division, Charleston, WV., Goyal N; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN., Arthur A; Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, TN., Schellinger PD; Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany., Köhrmann M; Department of Neurology, Essen University Hospital, Essen, Germany., Krogias C; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Turc G; Department of Neurology, Saint Anne Hospital, Paris, France.; Paris Descartes University, Paris, France.; National Institute of Health and Medical Research U1266, Paris, France.; NeuroVasc University Hospital Department, Sorbonne Paris Cité, Paris, France., Magoufis G; Metropolitan Hospital, Piraeus, Greece., Leys D; University of Lille, National Institute of Health and Medical Research U1171, Lille University Hospital Center, Lille, France., Ahmed N; Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden., Khatri P; University of Cincinnati, Cincinnati, OH., Goyal M; Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Radiology, Seaman Family Magnetic Resonance Research Centre, Foothills Medical Centre, Alberta, Canada., Alexandrov AV; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN., Tsivgoulis G; Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
المصدر: Annals of neurology [Ann Neurol] 2019 Sep; Vol. 86 (3), pp. 395-406. Date of Electronic Publication: 2019 Jul 22.
نوع المنشور: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Systematic Review
اللغة: English
بيانات الدورية: Publisher: Wiley-Liss Country of Publication: United States NLM ID: 7707449 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-8249 (Electronic) Linking ISSN: 03645134 NLM ISO Abbreviation: Ann Neurol Subsets: MEDLINE
أسماء مطبوعة: Publication: New York, NY : Wiley-Liss
Original Publication: Boston, Little, Brown.
مواضيع طبية MeSH: Brain Ischemia/*drug therapy , Brain Ischemia/*therapy , Combined Modality Therapy/*statistics & numerical data , Stroke/*drug therapy , Stroke/*therapy , Thrombectomy/*statistics & numerical data , Thrombolytic Therapy/*statistics & numerical data, Administration, Intravenous ; Brain Ischemia/complications ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/therapeutic use ; Humans ; Stroke/complications ; Thrombectomy/methods ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/methods ; Treatment Outcome
مستخلص: Objective: The substantial clinical improvement in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT), combined with the poor response of proximal intracranial occlusions to intravenous thrombolysis (IVT), led to questions regarding the utility of bridging therapy (BT; IVT followed by MT) compared to direct mechanical thrombectomy (dMT) for AIS patients with large vessel occlusion (LVO).
Methods: We aimed to investigate the comparative safety and efficacy of BT and dMT in AIS patients. We included all observational studies and post hoc analyses from randomized controlled clinical trials that provided data on the outcomes of AIS patients with LVO stratified by IVT treatment status prior to MT.
Results: We identified 38 eligible observational studies (11,798 LVO patients, mean age = 68 years, 56% treated with BT). In unadjusted analyses, BT was associated with a higher likelihood of 3-month functional independence (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.32-1.76), 3-month functional improvement (common OR [cOR] for 1-point decrease in modified Rankin Scale score = 1.52, 95% CI = 1.18-1.97), early neurological improvement (OR = 1.21, 95% CI = 1.83-1.76), successful recanalization (OR = 1.22, 95% CI = 1.02-1.46), and successful recanalization with ≤2 device passes (OR = 2.28, 95% CI = 1.43-3.64) compared to dMT. BT was also related to a lower likelihood of 3-month mortality (OR = 0.64, 95% CI = 0.57-0.73). In the adjusted analyses, BT was independently associated with a higher likelihood of 3-month functional independence (adjusted OR = 1.55, 95% CI = 1.26-1.91) and lower odds of 3-month mortality (adjusted OR = 0.80, 95% CI = 0.66-0.97) compared to dMT. The two groups did not differ in functional improvement (adjusted cOR = 1.24, 95% CI = 0.89-1.74) or symptomatic intracranial hemorrhage (adjusted OR = 0.87, 95% CI = 0.61-1.25).
Interpretation: BT appears to be associated with improved functional independence without evidence for safety concerns, compared to dMT, for AIS patients with LVO. ANN NEUROL 2019;86:395-406.
(© 2019 American Neurological Association.)
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المشرفين على المادة: 0 (Fibrinolytic Agents)
تواريخ الأحداث: Date Created: 20190709 Date Completed: 20200413 Latest Revision: 20200413
رمز التحديث: 20240628
DOI: 10.1002/ana.25544
PMID: 31282044
قاعدة البيانات: MEDLINE
الوصف
تدمد:1531-8249
DOI:10.1002/ana.25544