Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?

您当前的位置：

首页 >

文章列表页 >

Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?

Expert Reviews | 更新时间：2026-02-13

- Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?
- Journal of Third Military Medical University Vol. 43, Issue 14, Pages: 1299-1303(2021)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院神经内科
- 作者简介：
- 基金信息：
  
  the Major Program of National Natural Science Foundation of China(82090040);the General Program of National Natural Science Foundation of China(81071323)
- DOI：10.16016/j.1000-5404.202104153
  CLC： R743.33
- Received：22 April 2021，
  
  Revised：2021-05-16，
  
  Published：30 July 2021
- 稿件说明：
移动端阅览
Qingwu YANG, Wenjie ZI. Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?[J]. Journal of Third Military Medical University, 2021, 43(14): 1299-1303.
DOI：

Qingwu YANG, Wenjie ZI. Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?[J]. Journal of Third Military Medical University, 2021, 43(14): 1299-1303. DOI： 10.16016/j.1000-5404.202104153.

摘要

急性缺血性卒中早期管理指南推荐静脉溶栓桥接血管内治疗作为发病4.5 h内急性大血管闭塞致缺血性卒中的首选治疗方法。然而，血管内治疗前的阿替普酶静脉溶栓治疗是一把双刃剑，既可带来获益也可增加风险。是否可以跨过静脉溶栓，直接进行血管内治疗是目前卒中领域研究的焦点。已结束的4项针对发病4.5 h内急性大血管闭塞比较直接血管内治疗与静脉溶栓桥接血管内治疗有效性及安全性的多中心随机对照试验结果表明，直接血管内治疗组功能独立比例与静脉溶栓桥接血管内治疗组接近，两种治疗策略的症状性脑出血发生率及病死率差异无统计学意义。直接血管内治疗可能作为发病4.5 h内急性颅内大血管闭塞患者的新选择。

Abstract

Guidelines for the early management of acute ischemic stroke recommend intravenous thrombolysis followed by endovascular treatment as the first choice for the treatment of stroke with large vessel occlusion within 4.5 h of symptom onset. However

intravenous thrombolysis before endovascular treatment is a double-edged sword

which can not only bring benefits

but also increase risks. Currently

whether it is reasonable to omit intravenous thrombolysis and directly perform endovascular treatment is one of the most controversial issue. Four randomized

controlled

multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation demonstrated that the functional independence rate of the direct endovascular treatment group is similar to that of the intravenous thrombolysis followed by endovascular treatment group

and no significant difference was observed in the incidence of symptomatic intracerebral hemorrhage and mortality between the 2 treatment groups. Direct endovascular treatment may be used as a new option for patients with acute large vessel occlusion within 4.5 h of stroke onset.

关键词

Keywords

references

National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med, 1995, 333(24): 1581-1587. DOI:10.1056/NEJM199512143332401.

BERKHEMER O A, FRANSEN P S, BEUMER D, et al . A randomized trial of intraarterial treatment for acute ischemic stroke[J ] . N Engl J Med, 2015, 372(1): 11-20. DOI:10.1056/NEJMoa1411587.

JOVIN T G, CHAMORRO A, COBO E, et al . Thrombectomy within 8 hours after symptom onset in ischemic stroke[J ] . N Engl J Med, 2015, 372(24): 2296-2306. DOI:10.1056/NEJMoa1503780.

SAVER J L, G OYAL M, BONAFE A, et al . Stent-retriever thrombectomy after intravenous t-PA vs . t-PA alone in stroke[J ] . N Engl J Med, 2015, 372(24): 2285-2295. DOI:10.1056/NEJMoa1415061..

GOYAL M, MENON B K, VAN ZWAM W H, et al . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J ] . Lancet, 2016, 387(10029): 1723-1731. DOI:10.1016/S0140-6736(16)00163-X.

BHATIA R, HILL M D, SHOBHA N, et al . Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator inischemic stroke: Real-world experience and a call for action[J ] . Stroke, 2010, 41(10): 2254-2258. DOI:10.1161/STROKEAHA.110.592535.

CHANDRA R V, LESLIE-MAZWI T M, MEHTA B P, et al . Does the use of Ⅳ tPA in the current era of rapid and predictable recanalization by mechanical embolectomy represent good value?[J ] . J Neurointerv Surg, 2016, 8(5): 443-446. DOI:10.1136/neurintsurg-2015-012231.

REN Y F, CHURILOV L, MITCHELL P, et al . Clot migration is associated with intravenous thrombolysis in the setting of acute ischemic stroke[J ] . Stroke, 2018, 49(12): 3060-3062. DOI:10.1161/STROKEAHA.118.022751.

RAI A T, BOO S, BUSEMAN C, et al . Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes[J ] . J Neurointerv Surg, 2018, 10(1): 17-21. DOI:10.1136/neurintsurg-2016-012830.

中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018[J]. 中华神经科杂志, 2018, 51 (9): 683-691. DOI:10.3760/cma.j.issn.1006-7876.2018.09.005.

Branch of Neurology of Chinese Medical Association, Cerebrovascular Disease Group of Branch of Neurology of Chinese Medical Association, Neuro-intervention Group of Chinese Medical Association. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2018, 51 (9): 683-691. DOI:10.3760/cma.j.issn.1006-7876.2018.09.005.

POWERS W J, RABINSTEIN A A, ACKERSON T, et al . 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association[J ] . Stroke, 2018, 49(3): e46-e110. DOI:10.1161/STR.0000000000000158.

ZI W, QIU Z, LI F, et al . Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial[J ] . JAMA, 2021, 325(3): 234-243. DOI:10.1001/jama.2020.23523.

YANG P, ZHANG Y, ZHANG L, et al . Endovascular thrombectomy with or without intravenous alteplase in acute stroke[J ] . N Engl J Med, 2020, 382(21): 1981-1993. DOI:10.1056/NEJMoa2001123.

SUZUKI K, MATSUMARU Y, TAKEUCHI M, et al . Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: The skip randomized clinical trial[J ] . JAMA, 2021, 325(3): 244-253. DOI:10.1001/jama.2020.23522..

TREURNIET K M, LECOUFFE N E, KAPPELHOF M, et al . Mr clean-no iv: Intravenous treatment followed by endovascular treatment versus direct endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion-study protocol for a randomized clinical trial[J ] . Trials, 2021, 22(1): 141. DOI:10.1186/s13063-021-05063-5.

LIN C J, SAVER J L. Noninferiority margins in trials of thrombectomy devices for acute ischemic stroke: is the bar being set too low?[J]. Stroke, 2019, 50(12): 3519-3526. DOI:10.1161/STROKEAHA.119.026717.

GERSCHENFELD G, MURESAN I P, BLANC R, et al . Two paradigms for endovascular thrombectomy after intravenous thrombolysis for acute ischemic stroke[J ] . JAMA Neurol, 2017, 74(5): 549-556. DOI:10.1001/jamaneurol.2016.5823.

CAMPBELL B C V, MITCHELL P J, CHURILOV L, et al . Tenecteplase versus alteplase before thrombectomy for ischemic stroke[J ] . N Engl J Med, 2018, 378(17): 1573-1582. DOI:10.1056/NEJMoa1716405.

0

Views

0

下载量

0

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Related Articles

Efficacy of endovascular treatment for acute ischemic stroke with large core infarction and its influencing factors

Risk factors for stroke-associated pneumonia after endovasular treatment in acute anterior circulation ischemic stroke patients

Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study

Prenotification for thrombolysis before admission shortens door-to-needle time for patients with acute ischemic stroke

Related Author

Xue MA

Qian YI

Qiuju ZHAO

Li LEI

Meng ZHANG

Meng ZHANG

Shuhan HUANG

Xiaoshu LI

Related Institution

Department of Neurology, Daping Hospital, Army Medical University (Third Military Medical University)

Department of Neurology, Daping Hospital, Army Medical University

Department of Radiology, Daping Hospital, Army Medical University

Department of Neurology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Chongqing Center for Disease Control and Prevention

⁰