中等血管闭塞卒中血栓通透性与IVT/EVT疗效差异相关
本研究为单中心回顾性队列，纳入2018至2024年中国一家卒中中心收治的255例影像确诊中等血管闭塞（MeVO）患者，其中154例接受静脉溶栓（IVT），101例接受血管内治疗（EVT，可联合IVT）。结果显示血栓通透性指数（TPI）与治疗方式存在显著交互作用：高TPI患者从IVT获益更大，而低TPI患者可能更利于接受EVT。
要点
- MeVO患者高血栓通透性（TPI较高）与IVT后90天功能独立更好相关。
- 低TPI血栓患者接受EVT可能相对获益更大。
- TPI与症状性颅内出血和90天死亡率均无显著关联。
核心结论
- 在中等血管闭塞中，血栓通透性与治疗结局相关：高通透性有利于IVT相关获益，而EVT可能在低通透性血栓患者中相对更有利。
研究设计与样本
- 单中心回顾性队列研究，纳入255例影像确诊的中等血管闭塞患者，2018至2024年在中国一家卒中中心接受治疗。
- 154例接受IVT，101例接受EVT（可联合或不联合IVT）。
主要发现
- IVT组与EVT组的90天功能独立率相近（51.9%对51.5%；P=0.96）。
- 在逆概率治疗加权模型中，TPI与治疗方式存在显著交互作用（交互比值比0.37 [95% CI, 0.24–0.56]；P<0.001）。
- IVT组中，TPI每增加0.05单位，90天功能独立的比值比为1.73 [95% CI, 1.19–2.53]；P=0.005。
- EVT组中，TPI每增加0.05单位，90天功能独立的比值比为0.65 [95% CI, 0.49–0.87]；P=0.003。
- 探索性分析显示IVT亚组中随TPI升高功能独立率持续增加，未发现稳定截断值。
关键数值与推荐
- 血栓通透性通过非增强CT与CT血管造影计算血栓通透性指数（TPI）来量化。
- 90天功能独立定义为改良Rankin量表评分≤2分。
- 主要分析采用多变量logistic回归和逆概率治疗加权评估TPI与治疗方式的交互作用。
临床怎么用
- 对于MeVO患者，TPI可作为选择IVT或EVT的潜在参考指标。
- 高TPI患者可优先考虑IVT，低TPI患者可优先考虑EVT。
局限性
- 单中心回顾性研究，存在选择偏倚和混杂风险。
- 探索性分析未发现稳定TPI截断值，临床应用阈值尚不明确。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Stroke, Volume 57, Issue 10, Page 3069-3080, October 1, 2026. BACKGROUND:In acute ischemic stroke due to medium vessel occlusion, the relative effectiveness of intravenous thrombolysis (IVT) and endovascular therapy (EVT) remains controversial, and treatment benefits may vary across patients. We evaluated the interaction between thrombus perviousness and treatment modality on 90-day functional outcome in patients with medium vessel occlusion.METHODS:This single-center retrospective cohort study analyzed 255 patients with imaging-confirmed medium vessel occlusion treated at a stroke center in China between 2018 and 2024 (154 IVT and 101 EVT with or without prior IVT). Thrombus perviousness was quantified using the thrombus perviousness index (TPI) from noncontrast computed tomography and computed tomography angiography. Multivariable logistic regression and inverse probability of treatment weighting evaluated the TPI-by-treatment interaction for 90-day functional independence (modified Rankin Scale score ≤2). Sensitivity analyses used alternative weighting strategies and a surrogate thrombus perviousness measure.RESULTS:The 90-day functional independence rate was similar between the IVT and EVT groups (51.9% versus 51.5%;P=0.96), and TPI was not independently associated with outcome. In the inverse probability of treatment weighting-weighted model, a significant interaction between TPI and treatment modality was observed (interaction odds ratio, 0.37 [95% CI, 0.24–0.56];P<0.001). Higher TPI was associated with a greater likelihood of functional independence in IVT-treated patients (odds ratio per 0.05-unit increase, 1.73 [95% CI, 1.19–2.53];P=0.005), but lower odds in EVT-treated patients (odds ratio, 0.65 [95% CI, 0.49–0.87];P=0.003). Exploratory analyses in the IVT subgroup revealed a continuous increase in functional independence as TPI increased, without a stable cutoff. Rates of symptomatic intracranial hemorrhage and 90-day mortality did not differ between groups, and TPI was not associated with hemorrhage risk.CONCLUSIONS:In medium vessel occlusion, thrombus perviousness was associated with treatment outcomes, with higher perviousness favoring IVT-related benefits, whereas the use of EVT may be relatively advantageous in patients with low-perviousness thrombi.
引用
- Stroke：Thrombus Perviousness Is Associated With Differential Treatment Outcomes Following IVT and EVT in MeVO Stroke
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。