Arnold Marcel, Nedeltchev Krassen, Brekenfeld Caspar, Fischer Urs, Remonda Luca, Schroth Gerhard, Mattle Heinrich
Department of Neurology, University of Berne, Berne, Switzerland.
Stroke. 2004 May;35(5):1135-8. doi: 10.1161/01.STR.0000125862.55804.29. Epub 2004 Apr 8.
The aim of this study was to determine the clinical and radiological outcome of acute stroke patients who had no vessel occlusion on arteriography and to define predictors of clinical outcome.
We analyzed clinical and radiological data of stroke patients whose arteriography performed within 6 hours of symptom onset did not visualize any vessel occlusion.
Twenty-eight of 283 consecutive patients (10%) who underwent arteriography with the intention to perform intraarterial thrombolysis did not show any arterial occlusion. Their median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Time from symptom onset to arteriography ranged from 115 to 315 minutes; on average, it was 226 minutes. Presumed stroke cause was cardiac embolism in 11 patients (39%), small artery disease in 6 (21%), coronary angiography in 1 (4%), and undetermined in 10 patients (36%). After 3 months, modified Rankin Scale score (mRS) was < or =2 in 21 patients (75%), indicating a favorable outcome. Six patients (21%) had a poor outcome (mRS 3 or 4) and 1 patient (4%) had a myocardial infarction and died. Twenty-seven patients had follow-up brain imaging. It was normal in 5, showed a lacunar lesion in 8, a striatocapsular infarct in 2, a small or medium-sized anterior circulation infarct in 6, multiple small anterior circulation infarcts in 2, and multiple posterior circulation infarcts in 4. No predictors of clinical outcome were identified.
Most acute stroke patients with normal early arteriography show infarcts on brain imaging; however, clinical outcome is usually favorable.
本研究的目的是确定动脉造影未显示血管闭塞的急性卒中患者的临床和影像学结局，并确定临床结局的预测因素。
我们分析了症状发作6小时内进行动脉造影且未显示任何血管闭塞的卒中患者的临床和影像学数据。
283例连续接受动脉造影以进行动脉内溶栓的患者中有28例（10%）未显示任何动脉闭塞。他们的基线美国国立卫生研究院卒中量表（NIHSS）评分中位数为7分。从症状发作到动脉造影的时间为115至315分钟；平均为226分钟。推测的卒中病因中，11例（39%）为心源性栓塞，6例（21%）为小动脉疾病，1例（4%）为冠状动脉造影，10例（36%）病因不明。3个月后，21例患者（75%）的改良Rankin量表评分（mRS）≤2分，表明预后良好。6例患者（21%）预后不良（mRS 3或4分），1例患者（4%）发生心肌梗死并死亡。27例患者进行了随访脑成像。5例正常，8例显示腔隙性病变，2例显示纹状囊梗死，6例显示中小面积前循环梗死，2例显示多发小面积前循环梗死，4例显示多发后循环梗死。未发现临床结局的预测因素。
大多数早期动脉造影正常的急性卒中患者脑成像显示梗死灶；然而，临床结局通常良好。
