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Does Intravenous Thrombolysis Influence the Time of Recanalization and Success of Mechanical Thrombectomy during the Acute Phase of Cerebral Infarction?
Cerebrovascular Diseases Extra Pub Date : 2020-04-28 , DOI: 10.1159/000507119
Guillaume Charbonnier 1, 2 , Louise Bonnet 3 , Benjamin Bouamra 3 , Fabrice Vuillier 3 , Giovanni Vitale 4 , Thierry Moulin 3 , Elisabeth Medeiros De Bustos 3 , Alessandra Biondi 4
Affiliation  

Objectives: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. Recanalization time is a key factor in the treatment of AIS. It has previously been suggested that intravenous thrombolysis (IVT) may be associated with a shorter recanalization time. The aim of our study was to investigate whether IVT or other factors could be associated with shorter or longer MT procedure times. Methods: We performed a retrospective analysis of a local cohort of patients treated by MT. We collected procedure time (puncture to recanalization and clot visualization to recanalization), demographic data, localization of the thrombus, antithrombotic treatment at arrival, IVT infusion, and stroke subtype at discharge according to the TOAST classification. We planned to analyze the full cohort and the successful revascularization subgroup. Results: There was no difference in procedure times between patients who received IVT and those who did not. In the successful revascularization subgroup, patients presenting with cardioembolic stroke had a significantly shorter time between clot visualizations and revascularization than the other patients (41 vs. 56 min, p = 0.024), but this was not the case in the full cohort. Also in the successful revascularization subgroup, the revascularization time was 76 vs. 61 min (p = 0.075) in patients presenting with tandem occlusion vs. the others, but there was no difference between these groups in the full cohort. Conclusions: There was no difference in terms of procedure times in patients treated by IVT and MT vs. patients treated by MT alone either in the full cohort or in the successful revascularization subgroup. The data from the successful revascularization subgroup may be useful for studying revascularization times, provided that data from procedures that were stopped prematurely by the operator due to the length of time since symptom onset is removed.
Cerebrovasc Dis Extra 2020;10:28–35


中文翻译:

静脉溶栓会影响脑梗死急性期的再通时间和机械血栓切除术的成功吗?

目的:机械血栓切除术(MT)是治疗大血管阻塞引起的急性缺血性中风(AIS)的有效方法。再通时间是治疗AIS的关键因素。以前已经提出静脉溶栓(IVT)可能与更短的再通时间有关。我们研究的目的是调查IVT或其他因素是否与更短或更长的MT手术时间有关。方法:我们对MT治疗的本地患者进行了回顾性分析。根据TOAST分类,我们收集了手术时间(从穿刺到再通以及从血凝块可视化到再通),人口统计数据,血栓定位,到达时的抗栓治疗,IVT输注和出院时的卒中亚型。我们计划分析整个队列和成功的血运重建亚组。结果:接受IVT的患者与未接受IVT的患者在手术时间上没有差异。在成功的血运重建亚组中,出现心脏栓塞性中风的患者在血栓显像和血运重建之间的时间明显短于其他患者(41 vs. 56 min,p= 0.024),但在整个队列中并非如此。同样,在成功的血运重建亚组中,出现串联阻塞的患者与其他患者的血运重建时间分别为76分钟和61分钟(p = 0.075),但是在整个队列中这两组之间没有差异。结论:在整个队列研究或成功的血运重建亚组中,IVT和MT治疗的患者与单纯MT治疗的患者在手术时间方面没有差异。成功的血运重建术亚组的数据可能对研究血运重建术时间可能有用,前提是操作员由于自症状发作以来的时间过长而过早停止了手术的数据。
Cerebrovasc Dis Extra 2020; 10:28–35
更新日期:2020-04-28
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