Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
J Stroke Cerebrovasc Dis. 2013 Aug;22(6):703-8. doi: 10.1016/j.jstrokecerebrovasdis.2011.10.003. Epub 2011 Nov 30.
Patients with wake-up stroke (WUS) are excluded from thrombolysis because of unknown time of symptom onset. Previous studies have reported similar stroke severity and early ischemic changes (EICs) in patients with WUS and stroke of known onset. These studies, however, included patients within a large timeframe to imaging or did not quantify EICs. The aim of our study was to quantify EICs of patients with WUS presenting within 3 hours of symptom recognition compared to standard 3-hours recombinant tissue plasminogen activator (rt-PA)-treated patients and assess the extent of ischemic lesion and functional independence at follow-up.
Patients were selected from our prospectively collected stroke database. Baseline and follow-up computed tomographic scans were graded with Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Clinical outcome measures were modified Rankin Scale score, mortality, and symptomatic intracerebral hemorrhage.
Demographic features, risk factors, stroke severity, and baseline ASPECTS were similar in both groups. WUS and rt-PA-treated patients had similar tissue outcome (median ASPECTS 7.0 vs 7.5; P = .202). Functional outcome was more favorable in rt-PA-treated patients (61.6% vs 43.1%; odds ratio [OR] 2.12; 95% confidence interval [CI] 1.05-4.28; P = .037). After adjusting for age, stroke severity, treatment, and EICs in less than one-third of middle cerebral artery territory, rt-PA and National Institutes of Health Stroke Scale scores remained the only significant predictors of outcome (OR 7.76; 95% CI 2.40-25.05; P = .001 and OR 0.74; 95% CI 0.67-0.82; P < .001, respectively).
Within 3 hours of symptom recognition, patients with WUS have EICs similar to rt-PA-treated patients. It is reasonable to expect that selected WUS patients might benefit from thrombolysis within 3 hours of symptom awareness.
由于症状发作时间未知，苏醒性卒中（WUS）患者被排除在溶栓治疗之外。既往研究报告称，WUS 患者与已知起病时间的卒中患者的卒中严重程度和早期缺血性改变（EICs）相似。然而，这些研究纳入了影像学检查时间跨度较大的患者，或未对 EICs 进行量化。本研究旨在定量比较症状识别后 3 小时内的 WUS 患者与标准 3 小时内接受重组组织型纤溶酶原激活剂（rt-PA）治疗的患者的 EICs，并评估随访时的缺血性病变范围和功能独立性。
从我们前瞻性收集的卒中数据库中选择患者。使用 Alberta 卒中项目早期计算机断层扫描评分（ASPECTS）对基线和随访的计算机断层扫描进行评分。临床结局测量指标为改良 Rankin 量表评分、死亡率和症状性颅内出血。
两组患者的人口统计学特征、危险因素、卒中严重程度和基线 ASPECTS 相似。WUS 患者和 rt-PA 治疗患者的组织结局相似（中位数 ASPECTS 分别为 7.0 分和 7.5 分；P =.202）。rt-PA 治疗患者的功能结局更有利（61.6% vs 43.1%；比值比 [OR] 2.12；95%置信区间 [CI] 1.05-4.28；P =.037）。在校正年龄、卒中严重程度、治疗和三分之一以下大脑中动脉区域的 EICs 后，rt-PA 和美国国立卫生研究院卒中量表评分仍然是结局的唯一显著预测因素（OR 7.76；95% CI 2.40-25.05；P =.001 和 OR 0.74；95% CI 0.67-0.82；P <.001）。
在症状识别后 3 小时内，WUS 患者有与 rt-PA 治疗患者相似的 EICs。有理由认为，在症状出现后 3 小时内，选择合适的 WUS 患者可能会从溶栓治疗中获益。
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