Sarikaya Hakan, Fischer Andrea, Valko Philipp O, Weck Anja, Braun Julia, Georgiadis Dimitrios, Baumgartner Ralf W
Department of Neurology, University Hospital of Zurich, Switzerland.
Neurol Res. 2011 Sep;33(7):701-7. doi: 10.1179/1743132811Y.0000000002.
Outcome of stroke patients selected with cerebral computed tomography for intravenous thrombolysis administered in clinical routine from 3 to 4.5 hours after symptoms onset is not well investigated. Aim of this single-center, prospective, observational study was to compare the safety and efficacy of intravenous alteplase given in routine clinical praxis 181-270 minutes (late) and within 180 minutes (early) after stroke onset in patients selected with cerebral computed tomography.
A total of 454 consecutive patients underwent intravenous thrombolysis within 4.5 hours after stroke onset. Sixty of 454 patients were excluded (inclusion in a controlled-randomized trial, n = 51; stroke mimics, n = 9). Of remaining 394 patients, 100 were included in the late group, and 294 were included in the early group. The outcome parameters of symptomatic intracranial hemorrhage at 24 hours, and mortality and favorable outcome (modified Rankin scale score 0-1) at 3 months, and its predictors were investigated.
In the late cohort, median baseline National Institutes of Health Stroke Scale score was lower (9.5, interquartile range (IQR): 5-13; 11.3, IQR: 6-16; P = 0.01), and median time-to-treatment was longer (209, IQR: 190-222 minutes; 142, IQR: 125-170 minutes; P<0.0001) than in the early group. The incidence of symptomatic intracranial hemorrhage (2.0% versus 2.4%; P = 1.0), death (9.0% versus 9.9%; P = 1.0) and favorable outcome (58.0% versus 51.5%; P = 0.3) did not differ between the late and early cohorts.
These data suggest that intravenous alteplase administered 181-270 minutes after symptoms onset in stroke patients selected with cerebral computed tomography is also beneficial in real-life clinical practice.
对于在症状出现后3至4.5小时内通过头颅计算机断层扫描筛选出的中风患者进行临床常规静脉溶栓治疗的结果，目前尚未得到充分研究。这项单中心、前瞻性、观察性研究的目的是比较在头颅计算机断层扫描筛选出的患者中，在中风发作后181 - 270分钟（晚期）和180分钟内（早期）进行常规临床实践中静脉注射阿替普酶的安全性和有效性。
共有454例连续的患者在中风发作后4.5小时内接受了静脉溶栓治疗。454例患者中有60例被排除（纳入对照随机试验，n = 51；疑似中风，n = 9）。在其余394例患者中，100例被纳入晚期组，294例被纳入早期组。研究了24小时时症状性颅内出血的结局参数、3个月时的死亡率和良好结局（改良Rankin量表评分0 - 1）及其预测因素。
在晚期队列中，基线美国国立卫生研究院卒中量表评分中位数较低（9.5，四分位间距（IQR）：5 - 13；11.3，IQR：6 - 16；P = 0.01），且治疗时间中位数较长（209，IQR：190 - 222分钟；142，IQR：125 - 170分钟；P<0.0001），高于早期组。晚期和早期队列之间症状性颅内出血的发生率（2.0%对2.4%；P = 1.0）、死亡率（9.0%对9.9%；P = 1.0）和良好结局（58.0%对51.5%；P = 0.3）没有差异。
这些数据表明，对于通过头颅计算机断层扫描筛选出的中风患者，在症状出现后181 - 270分钟给予静脉注射阿替普酶在现实临床实践中也是有益的。
