지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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초록· 키워드
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Background and Purpose: Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse. Methods: INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale(mRS) scores at 3 months. Results: Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio[aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9). Conclusions: Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.
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참고문헌 (33)
참고문헌 신청
Rizvi A / 2019 / Redefining 'success' : a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization / J Neurointerv Surg 11:9~13
Liebeskind DS / 2019 / eTICI reperfusion : defining success in endovascular stroke therapy / J Neurointerv Surg 11:433~438
Kaesmacher J / 2018 / Systematic review and metaanalysis on outcome differences among patients with TICI2b versus TICI3 reperfusions : success revisited / J Neurol Neurosurg Psychiatry 89:910~917
Kaesmacher J / 2018 / Reasons for reperfusion failures in stentretriever-based thrombectomy : registry analysis and proposal of a classification system / AJNR Am J Neuroradiol 39:1848~1853
Leischner H / 2019 / Reasons for failed endovascular recanalization attempts in stroke patients / J Neurointerv Surg 11:439~442
Liebeskind DS / 2019 / eTICI reperfusion : defining success in endovascular stroke therapy / J Neurointerv Surg 11:433~438
Kaesmacher J / 2018 / Systematic review and metaanalysis on outcome differences among patients with TICI2b versus TICI3 reperfusions : success revisited / J Neurol Neurosurg Psychiatry 89:910~917
Kaesmacher J / 2018 / Reasons for reperfusion failures in stentretriever-based thrombectomy : registry analysis and proposal of a classification system / AJNR Am J Neuroradiol 39:1848~1853
Leischner H / 2019 / Reasons for failed endovascular recanalization attempts in stroke patients / J Neurointerv Surg 11:439~442
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