溶栓评估及再通选择探索.ppt

Bridging Therapy No differences in symptomatic intracranial hemorrhage was found No differences in mortality was found Mazighi M, et al. Stroke, 2012;43:1302-08 Bridging Therapy Although these positive efficacy and safety findings favor the bridging therapy approach, there is no data from RCTs Randomized trial--Interventional Management of Stroke III (IMS-III) Target N=900 Iv rtPA alone (0.9 mg/kg) vs combined IV/IA (0.6 mg/kg over 30 min followed by immediate angiography. If clot is demonstrated, the neuro-interventionalist will then choose from currently available but trial defined intra-arterial treatment approaches. IAT will be given at maximum 2 mg bolus and 10 mg/hr, max 22 mg) using standard microcathether. The?Interventional?Management?of?Stroke?(IMS-III?trial ) The patients who had received intravenous t-PA within 3 hours after symptom onset were randomly assigned to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio The primary outcome measure: a modified Rankin scale score of 2 or less at 90 days Broderick JP, et al. N Engl J Med, 2013;368:893-903 ( The?Interventional?Management?of?Stroke?(IMS)-III?trial ) The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone) The primary outcome measure did not differ significantly according to treatment (40.8% VS 38.7%, endovascular therapy VS intravenous t-PA) The endovascular therapy after intravenous t-PA showed similar safety outcomes and no significant difference in functional independence, as compared with intravenous t-PA alone Broderick JP, et al. N Engl J Med, 2013;368:893-903 血管内治疗 VS 静脉溶栓 endovascular therapy: - Intra-arterial thrombolysis - mechanical endovascular recanalization (clot disruption/extraction) - or combination 血管内治疗优于静脉溶栓吗？ Ciccone A, et al. N Engl J Med, 2013;368:904-13 ( The? SYNTHESIS E