Köhrmann M, Nowe T, Huttner H B, Engelhorn T, Struffert T, Kollmar R, Saake M, Doerfler A, Schwab S, Schellinger P D
Department of Neurology, University of Erlangen, Schwabachanlage 6, Erlangen, Germany.
Cerebrovasc Dis. 2009;27(2):160-6. doi: 10.1159/000185607. Epub 2008 Dec 18.
Thrombolytic therapy is frequently withheld in patients with minor stroke symptoms. However, recent studies demonstrate that a substantial proportion of these patients dies or remains permanently disabled because of underestimation of symptom severity at baseline or secondary deterioration. We aimed to assess the safety and outcome of thrombolysis therapy in patients with minor but disabling stroke symptoms.
32 patients presenting with mild symptoms were treated with intravenous recombinant tissue-type plasminogen activator between April 2006 and April 2008. Data were extracted from a prospectively collected database. Baseline demographic data, and clinical, laboratory and imaging findings were analyzed. Outcome was assessed using the modified Rankin Scale (mRS) score at 3 months and was dichotomized into favorable (mRS 0-1) versus unfavorable (mRS 2-6).
In the majority of patients, the left hemisphere was affected, with aphasia representing the most common symptom leading to treatment decision. The frequency of perfusion lesion (46%) and vessel occlusion (35%) at baseline was high but had no effect on the outcome at 3 months in our series of treated patients. Outcome was favorable in 94% of patients, and 47% recovered without any persisting symptom. Only one asymptomatic and no symptomatic hemorrhage was observed.
Our data support current guidelines and international licenses which give no lower National Institutes of Health Stroke Scale (NIHSS) limit for intravenous thrombolysis (IVT). Considering the accumulating evidence that the natural course in patients with mild symptoms is not as favorable as often assumed and taking the low risk of bleeding in those patients into account, patients with mild but disabling symptoms should be treated with IVT regardless of their baseline NIHSS score.
对于症状较轻的中风患者，溶栓治疗常常被延迟。然而，最近的研究表明，这些患者中有很大一部分因基线时症状严重程度被低估或继发恶化而死亡或永久性残疾。我们旨在评估对症状轻微但致残的中风患者进行溶栓治疗的安全性和疗效。
2006年4月至2008年4月期间，对32例症状轻微的患者进行了静脉注射重组组织型纤溶酶原激活剂治疗。数据来自前瞻性收集的数据库。分析了基线人口统计学数据以及临床、实验室和影像学检查结果。使用改良Rankin量表（mRS）评分在3个月时评估疗效，并将其分为良好（mRS 0 - 1）和不良（mRS 2 - 6）两类。
在大多数患者中，左侧半球受累，失语是导致治疗决策的最常见症状。基线时灌注损伤（46%）和血管闭塞（35%）的发生率较高，但在我们这组接受治疗的患者中，对3个月时的疗效没有影响。94%的患者疗效良好，47%的患者康复且无任何持续症状。仅观察到1例无症状出血，未观察到有症状出血。
我们的数据支持当前指南和国际许可，即对静脉溶栓（IVT）不设更低的美国国立卫生研究院卒中量表（NIHSS）下限。鉴于越来越多的证据表明症状轻微患者的自然病程并不像通常认为的那样良好，并考虑到这些患者出血风险较低，对于症状轻微但致残的患者，无论其基线NIHSS评分如何，都应进行IVT治疗。
