PT - JOURNAL ARTICLE AU -林龙婷AU -张昊AU -刘飞峰AU -陈晨AU -陈初双AU - Andrew Bivard AU - Mark W Parsons AU -李刚TI -核心生长较快的脑卒中患者血管内治疗前桥接溶栓DP - 2023 3月24日TA -神经病半岛投注体育官网学PG - 10.1212/WNL。0000000000207154 4099 - http://n.半岛投注体育官网neurology.org/content/early/2023/03/24/WNL.0000000000207154.short 4100 - //www.ebmtp.com/content/early/2023/03/24/WNL.0000000000207154.full AB -背景和目标:在急性缺血性患者中，直接进行血管内血栓切除术(EVT)是否能导致与桥接静脉溶栓(IVT)相当的结果仍不确定。本研究旨在探讨桥接IVT与直接EVT后缺血性核心生长速率是否影响患者预后。方法:这是一项基于国际脑卒中灌注成像登记(INSPIRE)的回顾性队列研究。选取卒中发病4.5小时内接受灌注CT的急性缺血性卒中患者。将直接进行EVT的患者与EVT之前接受IVT桥接治疗的患者进行比较。基于缺血核的线性生长模式假设，用灌注CT上急性缺血核体积除以卒中发病至灌注CT时间来估计缺血核的生长速率。核心生长速度分为快速(>15 mL/小时)和缓慢(≤15mL/小时)，基于其与桥接IVT的相互作用来预测主要结果。主要结局为3个月时修改Rankin评分0-2。次要结局包括成功的取栓再灌注，以脑梗死患者的改良溶栓评分为2b-3，以及从腹股沟穿刺到再灌注的时间。结果:在INSPIRE的1221例EVT患者中，选择了323例患者，其中82例患者接受了直接EVT, 241例患者接受了桥接IVT。 Bridging IVT was associated with a higher rate of good clinical outcome amongst patients with fast core growth (39% vs 7% for direct EVT, odds ratio=8.75 [1.96-39.1], p=0.005), but the difference was not significant for patients with slow core growth (55% vs 55% for direct EVT, odds ratio=1.00 [0.53-1.87], p=0.989). In patients with fast core growth, the bridging and direct EVT patients showed no difference in the reperfusion rate (80% vs. 76%, p=0.616). However, patients who received bridging IVT were more likely to achieve reperfusion earlier (the median groin to reperfusion time of 63.0 vs 94.0 minutes p=0.005).Discussion: Patients with fast core growth were more likely to benefit from bridging intravenous thrombolysis. This is likely because prior intravenous thrombolysis facilitates clot removal and thus reduces time to reperfusion.

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