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首页> 外文期刊>American Journal of Neuroradiology >Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Trial, Part I
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Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Trial, Part I

机译：机械血栓切除术和静脉组织纤溶酶原激活剂在急性缺血性卒中中的安全性。脑缺血（MERCI）试验中多机械栓塞去除的结果，第一部分

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BACKGROUND: The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) trial reported efficacy of the Merci Retriever for opening intracranial vessels in patients ineligible for intravenous (IV) tissue plasminogen activator (tPA). Patients who receive IV tPA but do not recanalize may also benefit from thrombectomy, but the revascularization efficacy and safety of this strategy has not been reported. METHODS: Multi MERCI is an ongoing international, multicenter, prospective, single-arm trial of patients with large vessel stroke treated within 8 hours of symptom onset. Patients were enrolled who had received IV tPA but did not recanalize or who were ineligible for IV tPA. Primary outcome was vascular recanalization (Thrombolysis in Myocardial Infarction [TIMI] score II/III) and safety. RESULTS: One hundred eleven patients received the thrombectomy procedure. Mean age ± SD was 66.2 ± 17.0 years, and baseline National Institutes of Health Stroke Scale (NIHSS) score was 19 ± 6.3. Thirty patients (27%) received IV tPA before intervention. Treatment with the Retriever alone resulted in successful recanalization in 60 of 111 (54%) treatable vessels and in 77 of 111 (69%) after adjunctive therapy (IA tPA, mechanical). Symptomatic intracranial hemorrhage (ICH) occurred in 10 of 111 (9.0%). Clinically significant procedural complications occurred in 5 of 111 (4.5%) patients. The symptomatic ICH rate was 2 of 30 (6.7%) in patients pretreated with IV tPA and 8 of 81 (9.9%) in those without (P > .99). CONCLUSIONS: Mechanical thrombectomy after IV tPA seems as safe as mechanical thrombectomy alone. Mechanical thrombectomy with both first- and second-generation Merci devices is efficacious in opening intracranial vessels during acute ischemic stroke in patients who are either ineligible for IV fibrinolytic therapy or have failed IV fibrinolytic therapy.
机译：背景：MERCI（脑缺血性栓子切除术）试验报告说，Mercci猎犬在不适合静脉 （）的患者中打开 颅内血管的功效。 IV）组织纤溶酶原激活剂（tPA）。接受 IV tPA但未再通管的患者也可能从血栓切除术中受益， 但尚未报道该策略 的血运重建效果和安全性。 方法：Multi MERCI是一项正在进行的国际，多中心， 前瞻性单臂试验，用于在症状的8小时内治疗大血管 的患者发作。接受了静脉tPA但未再通管或不符合静脉tPA的患者 入组。主要结局是血管再通 （心肌梗塞溶栓[TIMI] II / III级） 和安全性。 结果：1​​11例患者接受了血栓切除术 程序。平均年龄±SD为66.2±17.0岁， ，美国国立卫生研究院卒中量表（NIHSS）基线得分为19±6.3。干预前有30名患者（27％）接受了IV tPA。单独使用Retriever 进行的治疗成功地使111个可治疗的 血管中的60个以及再辅助治疗后111个中的77个（69％）再次通畅（IA tPA（机械）。 111例患者中有10例出现了症状性颅内出血（ICH） 。在111例患者中，有5例（4.5％）发生了具有临床意义的程序性 并发症。接受IV tPA 预处理的患者的有症状ICH发生率为30分之2（6.7％），而没有接受tPA 进行治疗的患者的有症状ICH发生率为81分（9.9％）（P> .99）。 结论：IV tPA后机械血栓切除术似乎与单纯机械血栓切除术一样安全。第一代和第二代Merci装置均采用 的机械血栓切除术在不符合以下条件的急性缺血性中风 期间有效打开颅内血管IV纤溶治疗 或IV纤溶治疗失败。

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