急性后循环大血管闭塞桥接治疗与直接取栓结局及相关因素研究：一项多中心前瞻性队列研究

目的 比较发病4.5 h内的急性后循环大血管闭塞患者静脉溶栓（intravenous thrombolysis，IVT）联合 血管内治疗（endovascular treatment，EVT）与直接取栓治疗的疗效差异。 方法 本研究为多中心前瞻性队列研究，连续纳入2018年7月-2019年5月全国18家分中心发病4.5 h 内的急性后循环大血管闭塞患者。根据实际治疗方式，分为桥接治疗组（IVT+EVT）和直接取栓组 （direct endovascular treatment，D-EVT）。主要结局为发病90 d的神经功能预后，良好预后定义为mRS评 分0～2分，采用多因素Logi sti c回归分析评估两组90 d预后的差异。 结果 研究纳入123例患者，平均年龄62.79±11.07岁，男性85例（69.11%），其中D -EVT组98例 （79.67%），IVT+EVT组25例（20.33%）。与IVT+EVT组相比，D-EVT组取栓≥3次病例更多（26.52% vs 8.00%，P =0.04）；多因素分析显示，IVT+EVT组良好预后比例高于D -EVT组（aOR 0.2，95%CI 0.06～0.71，P =0.01）。 结论 对于发病4.5 h内的急性后循环大血管闭塞患者，静脉溶栓联合血管内治疗较单纯血管内治 疗90 d神经功能预后更佳。

Endovascular Treatment with or without Intravenous Alteplase for Acute Ischemic Stroke due to Posterior-Circulation Large Vessel Occlusion: a Multicenter Prospective Cohort Study

Objective To investigate whether intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) adds additional benefit for acute ischemic stroke patients due to posterior-circulation large vessel occlusion (LVO) within 4.5 hours of onset in the real world. Methods This was a nationwide prospective register cohort study, which enrolled consecutive patients with acute posterior-circulation LVO within 4.5 hours of onset who received EVT with or without IVT from 18 national stroke centers between 2018 July to 2019 May. All the patients were divided into combined IVT and EVT group and direct EVT (D-EVT) group according to their actual treatment. The primary outcome was 90-day functional independence, and good outcome was defined as a mRS score of 0-2. The difference of the two groups in 90-day prognosis was compared. Results A total of 123 patients were included, with a mean age of 62.79±11.07 years old and 85 (69.11%) males. 98 (79.67%) cases were treated with D-EVT, and 25 (20.33%) with IVT+EVT. There were more patients with stent retriever passing ≥3 times in D-EVT group than in IVT+EVT group (26.52% vs 8.00%, P =0.04). The percentage of patients with good outcome in IVT+EVT group was higher than that in D-EVT group (aOR 0.2, 95%CI 0.06-0.71, P =0.01). Conclusions Compared with direct EVT, bridging therapy may be more favorable for acute posterior-circulation LVO within 4.5 hours of onset.