Efficacy analysis of bridging therapy and direct endovascular therapy in ischemic stroke patients with large vessel occlusion within 4.5 h of onset
10.3760/cma.j.cn115354-20200430-00323
- VernacularTitle:桥接治疗和直接取栓治疗发病4.5 h内大血管闭塞所致急性缺血性脑卒中的疗效对比分析
- Author:
Guifang WANG
1
;
Shuping LIU
;
Zuneng LU
;
Yilei XIAO
;
Zhangyong XIA
;
Xiaoqian YANG
;
Guisheng JIANG
;
Xiafeng YANG
;
Liyong ZHANG
;
Jiyue WANG
Author Information
1. 聊城市人民医院神经内科 252000
- Keywords:
Bridging therapy;
Direct endovascular therapy;
Large vessel occlusion;
Acute ischemic stroke
- From:
Chinese Journal of Neuromedicine
2020;19(9):865-872
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the efficacy of bridging therapy (BT) and direct endovascular therapy (DEVT) in patients with acute ischemic stroke induced by large vessel occlusion (LVO-AIS) within 4.5 h of onset.Methods:The clinical data of 154 patients with LVO-AIS within 4.5 h of onset, admitted to our hospital from January 2017 to July 2019, were retrospectively collected. Among them, 88 patients were hospitalized within 3 h of onset (54 accepted BT and 34 accepted DEVT); 66 patients were hospitalized within 3-4.5 h of onset (39 accepted BT and 27 accepted DEVT). The differences in clinical data and treatment efficacy between patients from the BT group and DEVT group that were hospitalized within 3 h of onset and within 3-4.5 h of onset, respectively, were compared. Multivariate Logistic regression was used to analyze the independent protective factors for favorable outcome 90 d after treatment in patients within 3.0-4.5 h of onset and within 3 h of onset, respectively.Results:(1) In patients within 3 h of onset: as compared with the DEVT group, the BT group had significantly higher improvement rate of neurological function at 24 h after treatment (41.2% vs. 70.4%) and higher percentage of patients enjoying favorable outcome 90 d after treatment (44.1% vs. 66.7%, P<0.05); multivariate Logistic regression analysis showed that BT was an independent protective factor for favorable outcome 90 d after treatment in patients within 3 h of onset ( OR=4.644, 95%CI: 1.238-12.805, P=0.041). (2) In patients within 3-4.5 h of onset: as compared with the BT group, the DEVT group had significantly higher proportion of patients having time from onset to groin puncture≤4 h, and significantly higher proportion of patients with favorable outcome 90 d after treatment ( P<0.05); multivariate Logistic regression analysis showed that the time from onset to groin puncture≤4 h was an independent protective factor for favorable outcome 90 d after treatment in patients within 3-4.5 h of onset ( OR=5.724, 95%CI: 1.192-11.676, P=0.024). Conclusion:For LVO-AIS patients, BT is the first choice in patients hospitalized in the early time window; and BT should be performed within 4 h of onset to the greatest extent for patients hospitalized in the late time window; if time from onset to groin puncture is not within 4 h, DEVT should be the first choice.
