Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the MR CLEAN Registry  

作　　者：Sabine L Collette Reinoud P H Bokkers Aryan Mazuri Geert J LycklamaàNijeholt Robert J van Oostenbrugge Natalie E LeCouffe Faysal Benali Charles B L M Majoie Jan Cees de Groot Gert Jan R Luijckx Maarten Uyttenboogaart 无 

机构地区：[1]Department of Radiology,Medical Imaging Centre,University Medical Centre Groningen,University of Groningen,Groningen,the Netherlands [2]Department of Radiology,Haaglanden Medical Centre,The Hague,the Netherlands [3]Department of Neurology,Cardiovascular Research Institute Maastricht(CARIM),Maastricht University Medical Centre,Maastricht,the Netherlands [4]Department of Neurology,Amsterdam UMC,University of Amsterdam,Amsterdam Neuroscience,Amsterdam,the Netherlands [5]Department of Radiology,Maastricht University Medical Centre,Maastricht,the Netherlands [6]Department of Radiology and Nuclear Medicine,Amsterdam UMC,University of Amsterdam,Amsterdam Neuroscience,Amsterdam,the Netherlands [7]Department of Neurology,University Medical Centre Groningen,University of Groningen,Groningen,the Netherlands [8]On behalf of the MR CLEAN Registry investigators

出　　处：《Stroke & Vascular Neurology》2023年第1期17-25,共9页卒中与血管神经病学（英文）

摘　　要：Introduction The efficacy and safety of local intra-arterial(IA)thrombolytics during endovascular thrombectomy(EVT)for large-vessel occlusions is uncertain.We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands(MR CLEAN)Registry,whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study,we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the MR CLEAN Registry(March 2014-November 2017).The primary endpoint was favourable functional outcome,defined as an modified Rankin Scale score≤2 at 90 days.Secondary endpoints were reperfusion status,early neurological recovery and symptomatic intracranial haemorrhage(sICH).Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients,95(4.2%)received IA thrombolytics during EVT.The IA thrombolytics administered were urokinase(median dose,250000 IU(IQR,193750-250000))or alteplase(median dose,20 mg(IQR,12-20)).No association was found between IA thrombolytics and favourable functional outcome(adjusted OR(aOR),1.16;95%CI 0.71 to 1.90).Successful reperfusion was less often observed in those patients treated with IA thrombolytics(aOR,0.57;95%CI 0.36 to 0.90).The odds of sICH(aOR,0.82;95%CI 0.32 to 2.10)and early neurological recovery were comparable between patients treated with and without IA thrombolytics.For primary and adjuvant revascularisation attempts,IA thrombolytics were more often administered for proximal than for distal occlusions.Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the MR CLEAN Registry.In the relatively small study sample,no statistical difference was obser

关 键 词：ARTERIAL throm acute 

分 类 号：R743.3[医药卫生—神经病学与精神病学]