Department of Neurology, Neurosurgery, and Radiology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.
Stroke. 2011 Nov;42(11):3144-9. doi: 10.1161/STROKEAHA.111.624163. Epub 2011 Sep 15.
Previous studies have demonstrated a strong correlation between treatment time and outcomes after intravenous recombinant tissue-type plasminogen activator. However, the temporal profile of ischemia may vary according to the level of occlusion, and it is likely that more proximal occlusions have a more variable temporal course than their distal counterparts. We sought to establish how time influences outcomes in anterior circulation proximal arterial occlusions.
All patients from the MERCI/Multi MERCI trials with intracranial internal carotid artery and/or middle cerebral artery (M1-M2 segments) occlusions who were successfully revascularized were included in univariate/multivariate analyses to define the predictors of independent functional outcomes (modified Rankin Scale score ≤2) and mortality at 90 days. The effect of time to reperfusion on outcomes was calculated after adjustment for age, baseline National Institutes of Health Stroke Scale, and glucose levels.
A total of 175 patients presenting with internal carotid artery/M1/M2 occlusions were revascularized. There was no definite association between time (to treatment or reperfusion) and outcomes in the unadjusted analysis. Baseline National Institutes of Health Stroke Scale score and age were independent predictors of independent outcome and mortality. High glucose demonstrated a strong trend toward worse outcomes. After adjustment for age, baseline National Institutes of Health Stroke Scale score, and glucose, there was a strong trend toward fewer independent outcomes with later reperfusion times. Notably, 40% of the patients reperfused at ≥6.9 hours achieved independent functional outcomes.
Time (to treatment or reperfusion) is only one of the many variables that may impact outcome in proximal arterial occlusions strokes. Reperfusion therapies should be started promptly, but our findings also suggest that stroke patients presenting at later time points may still benefit.
先前的研究表明，静脉注射重组组织型纤溶酶原激活剂后的治疗时间与预后之间存在很强的相关性。然而，缺血的时间进程可能因闭塞程度而异，近端闭塞的时间进程可能比远端闭塞更具变异性。我们旨在确定时间如何影响前循环近端动脉闭塞的结局。
MERCI/Multi MERCI 试验中所有颅内颈内动脉和/或大脑中动脉（M1-M2 段）闭塞且成功再通的患者均纳入单变量/多变量分析，以确定独立功能结局（改良 Rankin 量表评分≤2）和 90 天死亡率的预测因素。在调整年龄、基线国立卫生研究院卒中量表和血糖水平后，计算再灌注时间对结局的影响。
共 175 例颈内动脉/M1/M2 闭塞患者接受了再通治疗。在未调整的分析中，时间（治疗或再灌注）与结局之间没有明确的关联。基线国立卫生研究院卒中量表评分和年龄是独立的预后和死亡率预测因素。高血糖显示出与结局恶化的强烈趋势。在调整年龄、基线国立卫生研究院卒中量表评分和血糖后，再灌注时间较晚与独立结局减少呈强趋势。值得注意的是，40%再灌注时间≥6.9 小时的患者实现了独立的功能结局。
时间（治疗或再灌注）只是影响近端动脉闭塞性卒中结局的众多变量之一。再灌注治疗应尽快开始，但我们的发现还表明，较晚时间点就诊的卒中患者仍可能受益。
