急性缺血性卒中静脉溶栓桥接血管内治疗的疗效和安全性

目的 观察rt-PA静脉溶栓桥接血管内治疗急性缺血性卒中的临床疗效和安全性。 方法 回顾性纳入2017年1-12月郑州市第一人民医院神经重症科收治的前循环急性缺血性卒中患 者，按rt-PA静脉溶栓后是否桥接血管内治疗分为单纯静脉溶栓组和桥接治疗组。主要疗效结局为治 疗后3个月mRS评分，次要疗效结局为24 h、3 d和30 d的NI HSS评分。安全性结局为2 d症状性颅内出血及 其他部位出血、10 d全因死亡。 结果 共入组56例患者，平均年龄60.77±12.72岁，男性35例（62.5%）。单纯静脉溶栓组39例，桥接 治疗组17例。桥接治疗组3个月mRS评分≤2分比例高于单纯静脉溶栓组（88.2% vs 56.4%，P =0.021）。 两组治疗后24 h、3 d和30 d NIHSS评分差异无统计学意义。两组2 d症状性颅内出血率及其他部位出血 率、10 d全因死亡率差异无统计学意义。 结论 rt-PA静脉溶栓桥接血管内治疗可改善急性缺血性卒中患者3个月预后。

Efficacy and Safety of Intravenous Thrombolysis Bridging Endovascular Therapy for Acute Ischemic Stroke

Objective To observe the clinical efficacy and safety of rt-PA intravenous thrombolysis bridging
endovascular therapy in patients with acute ischemic stroke (AIS).
Methods Data of AIS patients who receiving intravenous thrombolysis and endovascular treatment
in the Department of Critical Care of the First Hospital of Zhengzhou from January 2017 to
December 2017 were selected. According to the treatment method, the patients were divided into
intravenous thrombolysis group and the bridging group. The intravenous thrombolysis group only
received rt-PA intravenous thrombolysis, while the bridging group received rt-PA intravenous
thrombolysis followed by endovascular treatment. The primary outcome was mRS score at 3
months, secondary outcome were the NIHSS score at 24 hours, 3 days and 30 days after the
procedure. Safety outcome was the symptomatic intracranial hemorrhage and other bleeding from
other sites within 2 days and all-cause death within 10 days.
Results A total of 56 patients were included in this study, with a mean age of 60.77±12.72 years old
and 35 (62.5%) males, 39 patients in intravenous thrombolysis group and 17 patients in the bridging
treatment group. The rate of mRS ≤2 at 3 months in the bridging treatment group was higher than
that in intravenous thrombolysis group (88.2% vs 56.4%, P =0.021). There was no statistical difference
in NIHSS score at 24 hours, 3 days and 30 days after treatment. There were no statistical differences
in the safety outcome between the two groups.
Conclusions rt-PA intravenous thrombolysis bridging endovascular treatment can improve the
prognosis of AIS patients at 3 months.