Stroke Units and Neurological Clinics/Department of Neurology, University Hospitals, Basel, Switzerland.
Eur J Neurol. 2010 Aug;17(8):1054-60. doi: 10.1111/j.1468-1331.2010.02961.x. Epub 2010 Feb 3.
Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO).
The safety of IVT in SAO-patients is addressed in this study.
We used the Swiss IVT databank to compare outcome and complications of IVT-treated SAO-patients with IVT-treated patients with other etiologies (non-SAO-patients). Main outcome and complication measures were independence (modified Rankin scale <or=2) at 3 months, intracranial hemorrhage (ICH), and recurrent ischaemic stroke.
Sixty-five (6.2%) of 1048 IVT-treated patients had SAO. Amongst SAO-patients, 1.5% (1/65) patients died, compared to 11.2% (110/983) in the non-SAO-group (P = 0.014). SAO-patients reached independence more often than non-SAO-patients (75.4% versus 58.9%; OR 2.14 (95% CI 1.20-3.81; P = 0.001). This association became insignificant after adjustment for age, gender, and stroke severity (OR 1.41 95% CI 0.713-2.788; P = 0.32). Glucose level and (to some degree) stroke severity but not age predicted 3-month-independence in IVT-treated SAO-patients. ICHs (all/symptomatic) were similar in SAO- (12.3%/4.6%) and non-SAO-patients (13.4%/5.3%; P > 0.8). Fatal ICH occurred in 3.3% of the non-SAO-patients but none amongst SAO-patients. Ischaemic stroke within 3 months after IVT reoccurred in 1.5% of SAO-patients and in 2.3% of non-SAO-patients (P = 0.68).
IVT-treated SAO-patients died less often and reached independence more often than IVT-treated non-SAO-patients. However, the variable 'SAO' was a dependent rather than an independent outcome predictor. The absence of an excess in ICH indicates that IVT seems not to be harmful in SAO-patients.
静脉溶栓（IVT）治疗脑卒中似乎与潜在病因无关，可带来获益。最近的观察结果引起了人们的担忧，即 IVT 可能会对小动脉闭塞（SAO）引起的脑卒中患者造成伤害。
本研究旨在评估 SAO 患者接受 IVT 的安全性。
我们使用瑞士 IVT 数据库，比较 IVT 治疗的 SAO 患者与 IVT 治疗其他病因（非 SAO 患者）患者的结局和并发症。主要结局和并发症测量指标为 3 个月时的独立性（改良 Rankin 量表≤2 分）、颅内出血（ICH）和复发性缺血性脑卒中。
1048 例 IVT 治疗患者中，有 65 例（6.2%）为 SAO。SAO 患者中，1.5%（1/65）的患者死亡，而非 SAO 组为 11.2%（110/983）（P = 0.014）。SAO 患者的独立性恢复率高于非 SAO 患者（75.4%比 58.9%；OR 2.14[95%CI 1.20-3.81]；P = 0.001）。但在调整年龄、性别和脑卒中严重程度后，这种关联变得无统计学意义（OR 1.41[95%CI 0.713-2.788]；P = 0.32）。血糖水平和（一定程度上）脑卒中严重程度而非年龄可预测 IVT 治疗的 SAO 患者 3 个月时的独立性。SAO 患者（ICH 发生率为 12.3%/症状性 ICH 发生率为 4.6%）与非 SAO 患者（ICH 发生率为 13.4%/症状性 ICH 发生率为 5.3%）的 ICH（全部/症状性）发生率相似（P > 0.8）。非 SAO 患者中，3.3%的患者发生致命性 ICH，而 SAO 患者中无一例发生。IVT 治疗后 3 个月内，SAO 患者中有 1.5%再次发生缺血性脑卒中，而非 SAO 患者中有 2.3%（P = 0.68）。
与 IVT 治疗的非 SAO 患者相比，IVT 治疗的 SAO 患者死亡更少，独立性更高。但是，“SAO”这一变量是一个依赖性的结局预测因素，而非独立性因素。ICH 发生率无增加表明 IVT 对 SAO 患者似乎没有危害。
