Molina C A, Montaner J, Abilleira S, Arenillas J F, Ribó M, Huertas R, Romero F, Alvarez-Sabín J
Cerebrovascular Unit, Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain.
Stroke. 2001 Dec 1;32(12):2821-7. doi: 10.1161/hs1201.99821.
The relationship between arterial recanalization, infarct size, and outcome in patients treated with intravenous thrombolytics remains unclear. Therefore, we aimed to determine the time course of recombinant tissue plasminogen activator (rtPA)-induced recanalization in patients with cardioembolic stroke treated <3 hours from symptom onset and to investigate the relationship between arterial recanalization, infarct volume, and outcome.
We prospectively studied 72 patients with an acute cardioembolic stroke in the middle cerebral artery territory: 24 treated with rtPA at <3 hours and 48 matched controls. Serial transcranial Doppler examinations were performed on admission and at 6,12, 24, and 48 hours. Infarct volume was measured by use of CT at day 5 to 7. Modified Rankin Scale score was used to assess outcome at 3 months.
Rate of 6-hour recanalization was higher (P<0.001) in the rtPA group (66%) than in the control group (15%). Five (20.8%) rtPA patients and 15 (31.2%) controls recanalized between 6 and 12 hours, and 2 (8.3%) patients and 12 (25%) controls between 12 and 48 hours, respectively. At 48 hours, 75% of rtPA patients and 27% of controls had improved (P<0.001). Infarct volume was 50.2+/-40.3 cm(3) in rtPA patients and 124.8+/-81.6 cm(3) in controls (P<0.001). Moreover, infarct volume was associated strongly (P<0.001) with duration of middle cerebral artery occlusion. At 3 months, 14 (58%) rtPA patients and 11 (23%) controls (P=0.037) became functionally independent (modified Rankin Scale score </=2). A close relationship (P=0.002) existed between modified Rankin Scale score at 3 months and time to reperfusion. In addition, clinical outcome was associated strongly (P=0.001) with degree of 6-hour recanalization. Logistic regression analysis identified National Institutes of Health Stroke Scale score <17 (odds ratio 12.1, 95% confidence interval 2.8 to 68, P=0.001) and early recanalization (odds ratio 23.4, 95% confidence interval 5.4 to 96, P=0.001) as independent predictors of functional independence at 3 months.
Intravenous rtPA is associated with early recanalization, which leads to lower infarct size and better clinical outcome. Early recanalization is a powerful independent predictor of functional independence at 3 months.
静脉溶栓治疗患者的动脉再通、梗死灶大小与预后之间的关系仍不明确。因此，我们旨在确定症状发作后<3小时接受治疗的心源性脑栓塞患者中重组组织型纤溶酶原激活剂（rtPA）诱导再通的时间进程，并研究动脉再通、梗死体积与预后之间的关系。
我们前瞻性研究了72例大脑中动脉区域急性心源性脑栓塞患者：24例在<3小时接受rtPA治疗，48例为匹配的对照组。入院时以及6、12、24和48小时进行了系列经颅多普勒检查。在第5至7天使用CT测量梗死体积。改良Rankin量表评分用于评估3个月时的预后。
rtPA组6小时再通率（66%）高于对照组（15%）（P<0.001）。5例（20.8%）rtPA患者和15例（31.2%）对照组在6至12小时之间再通，2例（8.3%）患者和12例（25%）对照组分别在12至48小时之间再通。在48小时时，75%的rtPA患者和27%的对照组病情改善（P<0.001）。rtPA患者的梗死体积为50.2±40.3 cm³，对照组为124.8±81.6 cm³（P<0.001）。此外，梗死体积与大脑中动脉闭塞持续时间密切相关（P<0.001）。在3个月时，14例（58%）rtPA患者和11例（23%）对照组（P=0.037）功能独立（改良Rankin量表评分≤2）。3个月时的改良Rankin量表评分与再灌注时间之间存在密切关系（P=0.002）。此外，临床预后与6小时再通程度密切相关（P=0.001）。Logistic回归分析确定美国国立卫生研究院卒中量表评分<17（比值比12.1，95%置信区间2.8至68，P=0.001）和早期再通（比值比23.4，95%置信区间5.4至96，P=0.001）是3个月时功能独立的独立预测因素。
静脉rtPA与早期再通相关，这导致梗死灶较小和临床预后较好。早期再通是3个月时功能独立的有力独立预测因素。
