Efficacy of Intravenous Thrombolysis Combined with Mechanical Stent Interventional Thrombectomy on Acute Ischemic Stroke

intravenous thrombolysis combined with mechanical stent interventional thrombectomy in acute ischemic stroke

  • Jun Huang
  • Ming Zhang
  • Qingbin Nie
  • Xinye Zhang
  • Xin He
  • Yufeng Yang
  • Gengsheng Mao Department of Neurosurgery, The Third Medical Centre Chinese PLA (People's Liberation Army) General Hospital
DOI: https://doi.org/10.5937/jomb0-35652
Keywords: thrombolysis, mechanical thrombectomy, acute ischemic stroke, efficacy

Abstract


Background: To investigate the efficacy and safety of intravenous thrombolysis combined with mechanical stent interventional thrombectomy in the treatment of acute ischemic stroke.

Methods: A retrospective analysis was carried out for clinical data of 118 patients with acute ischemic stroke admitted to our hospital from January 2017 to March 2018. The patients enrolled were divided into two groups according to different therapies, with 59 cases in each group. Patients in control group were administered with recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis on the basis of routine symptomatic treatment, while those in thrombectomy group underwent mechanical stent interventional thrombectomy based on rt-PA intravenous thrombolysis. The vascular recanalization rate and clinical efficacy after treatment were compared between the two groups. National Institutes of Health Stroke Scale (NIHSS) was used to identify the degree of neurological impairment in all patients before and after treatment, and Barthel Index was used to assess their activity of daily living. Moreover, the changes in the levels of T-lymphocyte subpopulation in peripheral blood and immuno-inflammatory factors before and after treatment were compared, and prognosis of patients and incidence of adverse reactions were recorded.  

Results: Clinical efficacy of all the patients was assessed at 3 months after treatment. The response rate was 93.2% (54/59) and 76.3% (45/59), respectively, in thrombectomy group and control group. It can be seen that the response rate in thrombectomy group was significantly better than that in control group (P=0.024). In the two groups, hemorrhage of digestive tract occurred in 3 cases and 2 cases, and skin and mucosal ecchymosis in 4 cases and 2 cases, respectively, which were all improved after symptomatic treatment. The NIHSS sore and modified Rankin scale (mRS) score after treatment were significantly lower than those before treatment, while the Barthel Index after treatment was distinctly higher than that before treatment (P<0.05). The NIHSS score and mRS score in thrombectomy group obviously declined compared with those in control group at 1 month after treatment (P<0.001), while they had no statistically significant differences at 2 months and 3 months after treatment between the two groups (P>0.05). The Barthel Index in thrombectomy group was obviously higher than that in control group at 1 month and 2 months after treatment (p=0.003, P=0.012), while its difference between the two groups was not statistically significant at 3 months after treatment (P>0.05). Levels of cluster of differentiation 3 (CD3)+, CD3+CD4+, CD4+/CD8+ and natural killer (NK) cells in peripheral blood at 6 months after treatment evidently rose compared with those before treatment (P<0.05), while level of CD3+CD8+ evidently declined compared with that before treatment (P<0.05). In thrombectomy group, levels of CD3+, CD3+CD4+, CD4+/CD8+ and NK cells were markedly higher than those in control group, while the level of CD3+CD8+ was markedly lower than that in control group (P<0.05). Besides, in thrombectomy group, levels of serum osteopontin (OPN), malondialdehyde (MDA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were evidently lower than those in control group at 1 month after treatment, while the level of serum superoxide dismutase (SOD) was evidently higher than that in control group (P<0.05). The differences in the proportion of patients in thrombolysis in cerebral infarction (TICI) grade ≥2b, residual stenosis rate, rate of 24 h symptomatic intracranial hemorrhage and survival rate were not statistically significant between the two groups (P>0.05). Compared with that in control group, the acute vascular re-occlusion rate in thrombectomy group was significantly decreased at 3 months after treatment (10.2% vs. 22.0%,       P=0.026).

Conclusions: Intravenous thrombolysis combined with mechanical stent interventional thrombectomy can effectively promote the vascular recanalization, improve the neurological function and activity of daily living of patients, reinforce the immunological function, inhibit the oxidative stress response and improve the prognosis of patients.

References


  1. Nam J, Jing H, O'Reilly D. Intra-arterial thrombolysis vs. standard treatment or intravenous thrombolysis in adults with acute ischemic stroke: a systematic review and meta-analysis. Int J Stroke 2015; 10(1): 13-22.

  2. Zafar M, Memon RS, Mussa M, Merchant R, Khurshid A, Khosa F. Does the administration of sonothrombolysis along with tissue plasminogen activator improve outcomes in acute ischemic stroke? A systematic review and meta-analysis. J Thromb Thrombolysis 2019; 48(2): 203-8.

  3. Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA 2015; 313(14): 1451-62.

  4. Warner JJ, Harrington RA, Sacco RL, Elkind M. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke 2019; 50(12): 3331-2.

  5. Powers WJ, Rabinstein AA. Response by Powers and Rabinstein to Letter Regarding Article, "2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke 2019; 50(9): e277-8.

  6. Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Rev Neurol (Paris) 2017; 173(3): 106-13.

  7. Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review. Can J Neurol Sci 2016; 43(4): 455-60.

  8. Diener HC, Bernstein R, Butcher K, Campbell B, Cloud G, Davalos A, et al. Thrombolysis and thrombectomy in patients treated with dabigatran with acute ischemic stroke: Expert opinion. Int J Stroke 2017; 12(1): 9-12.

  9. Minnerup J, Wersching H, Teuber A, Wellmann J, Eyding J, Weber R, et al. Outcome After Thrombectomy and Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Prospective Observational Study. Stroke 2016; 47(6): 1584-92.

  10. Hentschel KA, Daou B, Chalouhi N, Starke RM, Clark S, Gandhe A, et al. Comparison of non-stent retriever and stent retriever mechanical thrombectomy devices for the endovascular treatment of acute ischemic stroke. J Neurosurg 2017; 126(4): 1123-30.

  11. Atchaneeyasakul K, Leslie-Mazwi T, Donahue K, Giese AK, Rost NS. White Matter Hyperintensity Volume and Outcome of Mechanical Thrombectomy With Stentriever in Acute Ischemic Stroke. Stroke 2017; 48(10): 2892-4.

  12. Yilmaz U, Korner H, Muhl-Benninghaus R, Simgen A, Kraus C, Walter S, et al. Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions. Stroke 2017; 48(8): 2171-5.

  13. Tan CC, Wang HF, Ji JL, Tan MS, Tan L, Yu JT. Endovascular Treatment Versus Intravenous Thrombolysis for Acute Ischemic Stroke: a Quantitative Review and Meta-Analysis of 21 Randomized Trials. Mol Neurobiol 2017; 54(2): 1369-78.

  14. Bernardo F, Nannoni S, Strambo D, Bartolini B, Michel P, Sirimarco G. Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature. J Thromb Thrombolysis 2019; 48(4): 679-84.

  15. Ganesh A, Goyal M. Thrombectomy for Acute Ischemic Stroke: Recent Insights and Future Directions. Curr Neurol Neurosci Rep 2018; 18(9): 59.

  16. Campbell BC. Thrombolysis and Thrombectomy for Acute Ischemic Stroke: Strengths and Synergies. Semin Thromb Hemost 2017; 43(2): 185-90.

  17. Son S, Kang DH, Hwang YH, Kim YS, Kim YW. Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke. Acta Neurochir (Wien) 2017; 159(9): 1663-9.

  18. Ducroux C, Fahed R, Khoury NN, Gevry G, Kalsoum E, Labeyrie MA, et al. Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study. Rev Neurol (Paris) 2019; 175(6): 380-9.

  19. Mueller-Kronast NH, Zaidat OO, Froehler MT, Jahan R, Aziz-Sultan MA, Klucznik RP, et al. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry. Stroke 2017; 48(10): 2760-8.

  20. Pikija S, Sztriha LK, Killer-Oberpfalzer M, Weymayr F, Hecker C, Ramesmayer C, et al. Contribution of Serum Lipid Profiles to Outcome After Endovascular Thrombectomy for Anterior Circulation Ischemic Stroke. Mol Neurobiol 2019; 56(6): 4582-8.

Published
2022/04/18
Issue
Vol. 41 No. 4 (2022): Journal of Medical Biochemistry
Section
Original paper

Copyright (c) 2022 Jun Huang, Ming Zhang, Qingbin Nie, Xinye Zhang, Xin He, Yufeng Yang, Gengsheng Mao

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.