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Stroke is the leading cause of death in our country
.
According to reports, there are more than 3.
On May 21, 2020, the Liu Jianmin team of Naval Military Medical University published a research paper entitled "Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke" online in the top international medical journal NEJM.
This research is a prospective, multi-center, randomized research paper.
A controlled study, covering 41 academic tertiary hospitals across the country, screened a total of 1586 patients with anterior circulation acute large vessel occlusive ischemic stroke with an onset of less than 4.
5 hours.
Finally, 656 cases were included in the study and randomized at a ratio of 1:1 Divided into the direct thrombectomy group (simple intravascular thrombectomy, 327 cases) and the combined treatment group (pre-thrombectomy alteplase intravenous thrombolysis, alteplase administered at a dose of 0.
9 mg/kg, 329 cases )
.
The study found that intravascular thrombectomy alone was not inferior to intravenous alteplase and intravascular thrombectomy combined therapy (adjusted common odds ratio, 1.
07; 95% confidence interval, 0.
81 to 1.
40; non-inferiority P=0.
04 )
.
However, the rate of successful reperfusion before thrombectomy (2.
In conclusion, for patients with acute anterior circulation large vessel occlusive ischemic stroke within 4.
5 hours of onset, the effect of simple intravascular thrombus removal is not inferior to alteplase intravenous thrombolysis combined with intravascular removal in terms of improving functional outcomes.
Embolization
.
Faced with the worldwide problem of "stroke", in recent years, the standard treatment method of thrombolysis followed by thrombus removal has been generally recommended
.
However, due to limitations such as the division of inherent disciplines, poor regional referrals, and lack of sufficient understanding of patients, the combined therapy of intravenous thrombolysis and arterial thrombolysis is not ideal in the actual operation process, which greatly affects the treatment effect
Alteplase may increase the early reperfusion of the ischemic area and dissolve the residual distal thrombus after intravascular thrombus removal
.
However, for the large thrombus located at the proximal end, intravenous alteplase has a limited dissolution effect.
The study performed direct intra-arterial thrombectomy to effectively revascularize patients with acute ischemic stroke with large vessel occlusion in tertiary hospitals in China: a multicenter randomized clinical trial (DIRECT-MT) to identify individual vessels Is internal thrombectomy not inferior to intravenous alteplase followed by intravascular thrombectomy (acute ischemic stroke patients with anterior circulation large vessel occlusion)
?
The study is a prospective, multi-center, randomized controlled study covering 41 academic tertiary hospitals across the country.
A total of 1586 patients with anterior circulation acute macrovascular occlusive ischemic stroke with an onset of less than 4.
Of the 1586 patients screened, 656 were included, of which 327 patients were assigned to the thrombus removal group alone and 329 were assigned to the combined treatment group
.
In terms of the main outcome, intravascular thrombectomy alone was not inferior to intravenous alteplase and intravascular thrombectomy combined therapy (adjusted common odds ratio, 1.
In conclusion, for patients with acute anterior circulation large vessel occlusive ischemic stroke within 4.
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