Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA.
J Neurointerv Surg. 2012 Mar;4(2):105-9. doi: 10.1136/jnis.2010.004168. Epub 2011 May 23.
For acute ischemic stroke patients with matched defects on diffusion-perfusion imaging, the effects of reperfusion therapy remain poorly documented. The outcomes in a rare series of patients who had a matched defect and then underwent intra-arterial thrombolytic treatment (IAT) are reported.
Medical record and MR image review between 1 January 1998 and 15 October 2008 revealed only eight acute ischemic stroke patients satisfying the atypical combination of both matched defect and IAT. Successful recanalization (SR), favorable clinical response (FCR) and symptomatic intracranial hemorrhage (SICH) were defined respectively as thrombolysis in cerebral infarction score ≥2 after IAT, discharge National Institutes of Health Stroke Scale (NIHSS) 0-1/≥8 point decrease from baseline and intracranial hemorrhage in infarct zone with ≥4 point increase in NIHSS Score within 24 h of IAT.
Median (range) baseline NIHSS score was 16.5 (6-22). Median (range) time delays from symptom onset to MRI and to IAT initiation were 200 (83-240) and 267.5 (160-360) min, respectively. Median (range) values of diffusion and perfusion lesion volumes were 119.5 (24-205) and 118 (18-207) ml. Out of eight patients, one (12.5%) achieved FCR, four (50%) had SICH and five (62.5%) died. Out of six patients with SR, one achieved FCR and four had SICH and died, and of two patients without SR, none had FCR or SICH and one died.
Our data on rare patients with matched defects who nevertheless had attempted rescue with IAT confirm a poor risk-benefit ratio generated by low favorable responses and high mortality rates, especially in large ischemic lesions.
对于在弥散-灌注成像上具有匹配缺损的急性缺血性脑卒中患者，再灌注治疗的效果记录不佳。本文报告了罕见的一组接受动脉内溶栓治疗（IAT）的具有匹配缺损的患者的结局。
对 1998 年 1 月 1 日至 2008 年 10 月 15 日的病历和磁共振成像（MR）进行回顾性分析，仅发现 8 例满足不典型的匹配缺损和 IAT 联合特征的急性缺血性脑卒中患者。将成功再通（SR）、良好的临床反应（FCR）和症状性颅内出血（SICH）分别定义为 IAT 后血栓溶解评分（thrombolysis in cerebral infarction score）≥2、IAT 后出院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分 0-1/与基线相比降低≥8 分以及 IAT 后 24 小时内梗死区内的颅内出血伴 NIHSS 评分增加≥4 分。
中位（范围）基线 NIHSS 评分为 16.5（6-22）分。从症状发作到 MRI 和 IAT 开始的中位（范围）时间延迟分别为 200（83-240）和 267.5（160-360）min。弥散和灌注病变容积的中位数（范围）值分别为 119.5（24-205）和 118（18-207）ml。8 例患者中，1 例（12.5%）达到 FCR，4 例（50%）发生 SICH，5 例（62.5%）死亡。6 例 SR 患者中，1 例达到 FCR，4 例发生 SICH 和死亡，2 例无 SR 的患者均未达到 FCR 或 SICH，1 例死亡。
我们对接受 IAT 尝试挽救的罕见匹配缺损患者的数据证实，低良好反应率和高死亡率导致风险效益比较差，尤其是在大的缺血性病变中。
