在4.5到9小时内静脉溶栓是否会增加血栓的迁移，导致血管内取栓无法开展？

在4.5到9小时内静脉溶栓是否会增加血栓的迁移，导致血管内取栓无法开展？


摘要

背景和目的：急性缺血性卒中患者静脉溶栓（IVT）后，远端血栓迁移是公认的事件。值得注意的是，最初通过血管内血栓切除术可以恢复的血栓可能会转移到远端不可恢复的位置，影响临床结果。我们调查了在4.5到9小时的时间窗内，静脉血栓移植后血栓迁移导致血栓不可接近的发生率。


方法：我们对EXTEND试验（延长急诊神经功能缺损溶栓时间）的资料进行回顾性分析。根据CT血管造影或磁共振血管造影确定基线和12-24小时随访的血栓位置。两个治疗组（IVT组和安慰剂组）之间确定并比较了导致从可恢复到不可恢复位置变化的血栓迁移发生率。


结果：共评估220例患者。37例患者发生了血栓从可恢复部位向不可恢复部位的转移：安慰剂组21例（19.3%），IVT组16例（14.4%）。两组之间血栓迁移率无显著差异（P=0.336）。


结论：我们的研究结果没有显示在接受IVT治疗的患者中，血栓迁移增加导致无法取栓。

Stroke

. 2021 Mar;52(3):1083-1086.

 doi: 10.1161/STROKEAHA.120.030661. Epub 2021 Feb 16.

Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?

Jeremy C Lim 1, Leonid Churilov 2, Andrew Bivard 3, Henry Ma 3, Richard J Dowling 1, Bruce C V Campbell 3, Mark W Parsons 3, Stephen M Davis 3, Geoffrey A Donnan 3, Peter J Mitchell 1, Bernard Yan 3

Affiliations expand

• PMID: 33588590

•  

• DOI: 10.1161/STROKEAHA.120.030661

Abstract

Background and purpose: Distal clot migration is a recognized event following intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. Of note, clots that were initially retrievable by endovascular thrombectomy may migrate to a distal nonretrievable location and compromise clinical outcome. We investigated the incidence of clot migration leading to clot inaccessibility following IVT in the time window of 4.5 to 9 hours.

Methods: We performed a retrospective analysis of the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits) data. Baseline and 12- to 24-hour follow-up clot location was determined on computed tomography angiogram or magnetic resonance angiogram. The incidence of clot migration leading to a change from retrievable to nonretrievable location was identified and compared between the two treatment groups (IVT versus placebo).

Results: Two hundred twenty patients were assessed. Clot migration from a retrievable to nonretrievable location occurred in 37 patients: 21 patients (19.3%) in the placebo group and 16 patients (14.4%) in the IVT group. No significant difference was identified in the incidence of clot migration leading to inaccessibility between groups (P=0.336).

Conclusions: Our results did not show increased clot migration leading to clot inaccessibility in patients treated with IVT.

Keywords: endovascular procedures; follow-up; incidence; radiology, interventional; thrombolytic therapy.