Direct arterial thrombosis is expected to treat stroke more quickly

May 7, the results of the "Assessment of the Efficacy of Direct Arterial Therapy for Ischemic Stroke in China" (DIRECT-MT), led by Liu Jianmin, director of neurosurgery at Changhai Hospital, affiliated with naval military medical university, were officially published in the New England Journal of Medicine. The results showed that for patients with acute large vascular thrombosis ischemic stroke within 4.5 hours of onset, the functional outcome of vascular intravascular thrombosis alone was not inferior to that of artipase venous thrombosis combined with intravascular thrombosis.Craig Anderson,
's internationally renowned expert on cerebrovascular diseases and former president of the Asia Pacific Stroke Agency, said: "This study opens up new ground for acute ischemic stroke treatment, with a very high quality of research and setting a new benchmark for the implementation of future clinical studies.stroke is commonly known as a stroke, a group of diseases, including hemorrhagic and ischemic strokes, that cause damage to brain tissue due to sudden rupture of blood vessels in the brain or the inability of blood to flow into the brain due to blocked blood vessels.
stroke is the first cause of death and disability among adults in China, characterized by high morbidity, high disability rate, high mortality rate and high recurrence rate. The New England Journal of 2018 reported that the risk of stroke in the lifetime of Chinese over the age of 25 is 39.3 percent, and the incidence rate is increasing at an annual rate of 8.7 percent, significantly higher than the overall annual incidence of stroke in the world.
" 70% to 80% of strokes are ischemic stroke, and acute large vascular cystic ischemic stroke is one of the most serious types, therefore, we focus on this type of stroke. Yang Pengfei, the first author of the paper and deputy director of neurosurgery at Changhai Hospital, affiliated with naval military medical university, told China Science Daily that standard treatment methods for the diagnosis and treatment of acute ischemic stroke in Europe and the United States, as well as in China, generally recommend the use of venous thrombosis and then hydrants.
1995, a study published in the New England Journal of Medicine confirmed the clinical efficacy of atipase venous thrombosis, and in 1996, the FDA approved aipase for clinical use. In 2015, the treatment of acute ischemic stroke made a revolutionary breakthrough. The study confirmed that arterial thrombosis on the basis of venous thrombosis can significantly improve the clinical outcome of patients and reduce the rate of disability.
Therefore, the world's medical guidelines are recommended at the highest level, for the onset of 4.5 hours of acute large vascular thrombosis ischemic stroke patients, if the guidelines meet the conditions, to first carry out venous thrombosis and then transferred to the catheter room action vasculation treatment. "For patients with acute large vascular reforestation ischemic stroke with a pathogenesis of more than 4.5 hours, clinically direct action vasculation treatment is generally expected." Yang Pengfei added.
, the pros and cons of implementing venous thrombosis before arterial thrombosis are not clear, and there is a lot of controversy. Yang Pengfei said that whether it is possible to skip the venous thrombosis direct action pulse thrombosis treatment, is the focus of this type of stroke treatment. This question concerns the optimization and layout of the entire treatment process, and scholars around the world are paying attention to its answers.。 The DIRECT-MT study was launched in 2016 and is conducted simultaneously in Central Europe. The Chinese research team, consisting of 41 national senior stroke centers in 18 provinces and cities, achieved the first patient entry in February 2018, completed the last patient entry in July 2019, and completed all patient follow-up in October of the same year.
the study follows the highest international clinical research standards, requiring accurate data entry and reasonable supervision of the research process. "This study is not about adding surgery or innovating surgical techniques, it's about reducing the use of a drug, so it's not going to be more difficult to operate at the technical level." Liu Jianmin said the difficulty of the study is to maintain multi-center coordination and unity under high international standards of operation.
group selected patients with acute large vascular thrombosis stroke with venous thrombosis within 4.5 hours, and screened a total of 1586 patients and 656 cases in the group. Of these, 327 cases were randomly assigned to the direct hydrant group (separate direct intravascular mechanical thrombosis treatment) and 329 cases were assigned to the combined treatment group (intravenous drug atipase thrombosis and then arterial thrombosis). The difference between the two methods is then evaluated.
results showed that direct thrombosis treatment was no worse than arterial thrombosis treatment after intravenous thrombosis drugs: the rate of successful vascular retransmosis in the direct thrombosis group was lower than 5.1% in the combined treatment group, and the difference was not significant, while the mortality rate of patients in the direct thrombosis group was lower than that in the combined treatment group 1.1% within 90 days.Liu Jianmin,
, made an example: "It's like a water pipe in your house, do you use melting agent to clear the pipe before you pull it out, or do you use a hook to pull out the blockage." And our research proves that it's not bad to go straight with a hook. He said the study offers another possibility and thinking about the optimal treatment for stroke patients, who can choose how to quickly open the pipeline based on existing conditions.Although, for patients with acute large vascular thrombosis ischemic stroke within 4.5 hours of onset, intravenous thrombosis treatment as soon as possible is standard treatment measures, but in practice, due to differences in patient arrival time, hospital green channel efficiency differences and referral delays and many other factors, the close combination of these two methods is sometimes not ideal.
Yang Pengfei explains that the potential advantage of intravenous thrombosis prior to hydration is that it is possible to make the re-flow of closed blood vessels earlier and more complete, and is therefore the usual strategy for stroke therapy. However, this option may delay in-vascular surgery and increase the risk of bleeding and treatment costs.
" thrombolytic drug itself has many limitations, especially the high rate of re-passing of large vascular thrombosis, so the proportion of patients who benefit clinically is not high. Yang Pengfei said.
DIRECT-MT study confirms the results of direct arterial thrombosis treatment and is no worse than the standard treatment recommended in existing guidelines, meaning that future clinicians can choose a more appropriate treatment for patients based on their condition and the different conditions in their respective centers.
, associate editor of the New England Journal of Medicine and director of the Institute of Molecular Medicine at Peking University, said the findings were highly recognized by peers around the world and were expected to change international guidelines.
" under the guidance of the treatment concept, acute ischemic stroke treatment is expected to reduce the treatment link, speed up treatment, save medical resources and patient costs. Liu Jianmin told China Science Daily.
the pros and cons of venous thrombosis before arterial thrombosis, five international clinical studies are being conducted at the same time. "I believe that in the next few years, with the release of these findings, it will change the current state of stroke treatment around the world." Liu Jianmin said. (Source: Xin Yu, China Science Daily)
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