Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion  

作　　者：Ximing Nie David Wang Yuehua Pu Yufei Wei Qixuan Lu Hongyi Yan Xin Liu Lina Zheng Jingyi Liu Xinxuan Yang Yarong Ding Dacheng Liu Wanying Duan Zhe Zhang Zhonghua Yang Miao Wen Weibin Gu Xinyi Hou Xinyi Leng Yuesong Pan Zhongrong Miao Liping Liu 

机构地区：[1]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [2]China National Clinical Research Center for Neurological Diseases,Beijing,China [3]Neurovascular Division,Department of Neurology,Barrow Neurological Institute,Phoenix,Arizona,USA [4]Department of Medicine and Therapeutics,Prince of Wales Hospital,Hong Kong,China [5]Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [6]Department of Interventional Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China

出　　处：《Stroke & Vascular Neurology》2022年第3期190-199,共10页卒中与血管神经病学（英文）

基　　金：This work was supported by the National Key R&D Program of China(2016YFC1307301);the National Natural Science Foundation of China(81820108012);This study was partially funded by Boehringer Ingelheim China.

摘　　要：Background and purpose It remains controversial if endovascular treatment(EVT)can improve the outcome of patients with acute basilar artery occlusion(BAO).This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis(IVT)first in patients who had acute ischaemic stroke(AIS)due to BAO.Methods Patients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study,and the efficacy and safety were compared between IVT+EVT and direct EVT.The primary outcome was 90-day functional independence.All outcomes were assessed with adjusted OR(aOR)from the multivariable logistic regression.In addition,a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.Results Of 310 enrolled patients with BAO,241(78%)were treated with direct EVT and 69(22%)with IVT+EVT.Direct EVT was associated with a worse functional outcome(aOR,0.46(95%CI 0.24 to 0.85),p=0.01).IVT+EVT was associated with a lower percentage of patients who needed≥3 passes of stent retriever(10.14%vs 20.75%).The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence(r=0.14(95%CI 0.05 to 0.24),p<0.01).Conclusions This study showed that compared with direct EVT,EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset.The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

关 键 词：ACUTE INTRAVENOUS OCCLUSION 

分 类 号：R741[医药卫生—神经病学与精神病学]