Department of Neurology, University Hospital of Coimbra, Coimbra, Portugal.
Stroke. 2012 Feb;43(2):417-21. doi: 10.1161/STROKEAHA.111.632653. Epub 2011 Dec 1.
Information on the clinical and hemodynamic profile of intravenous tissue-type plasminogen activator nonresponders, at different locations of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aim to investigate predictors of failing intravenous tissue-type plasminogen activator therapy according to occluded vessel and location of the clot.
We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal middle cerebral artery occlusion (n=251), distal middle cerebral artery occlusion (n=194), internal carotid artery bifurcation occlusion (n=61), and basilar artery occlusion (n=42). Recanalization was assessed on transcranial Doppler at 1 hour of tissue-type plasminogen activator bolus.
Among patients with proximal middle cerebral artery occlusion, the presence of severe extracranial internal carotid artery stenosis or occlusion (OR, 2.36; 95% CI, 1.15-4.84; P=0.02) and age >74 years (OR, 1.84; 95% CI, 1.02-3.31; P=0.04) independently predicted no recanalization. No independent predictors of no recanalization were identified in patients with distal middle cerebral artery occlusion. In patients with internal carotid artery bifurcation occlusion, a previous diagnosis of hypertension (OR, 12.77; 95% CI, 2.12-76.88; P=0.05), and absence of atrial fibrillation (OR, 8.15; 95% CI, 1.40-47.44; P=0.02) emerged as independent predictors of no recanalization. Similarly, among patients with basilar artery occlusion, absence of atrial fibrillation was as an independent predictor of no recanalization (OR, 7.50; 95% CI, 1.40-40.35; P=0.02).
The use of relevant predictors of no recanalization and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.
了解不同部位动脉闭塞的静脉组织型纤溶酶原激活剂无反应者的临床和血液动力学特征，可能有助于选择接受挽救性再灌注治疗的患者。因此，我们旨在根据闭塞血管和血栓部位，研究静脉组织型纤溶酶原激活剂治疗失败的预测因素。
我们前瞻性评估了发病后 6 小时内入院的连续急性缺血性脑卒中患者。共纳入 548 例有明确颅内闭塞的患者。根据血管闭塞部位将患者分为 4 个不同的组：近端大脑中动脉闭塞（n=251）、远端大脑中动脉闭塞（n=194）、颈内动脉分叉部闭塞（n=61）和基底动脉闭塞（n=42）。在组织型纤溶酶原激活剂推注后 1 小时，经颅多普勒超声评估再通情况。
在近端大脑中动脉闭塞患者中，存在严重的颅外颈内动脉狭窄或闭塞（OR，2.36；95%CI，1.15-4.84；P=0.02）和年龄＞74 岁（OR，1.84；95%CI，1.02-3.31；P=0.04）是不能再通的独立预测因素。在远端大脑中动脉闭塞患者中，未发现不能再通的独立预测因素。在颈内动脉分叉部闭塞患者中，既往高血压诊断（OR，12.77；95%CI，2.12-76.88；P=0.05）和无房颤（OR，8.15；95%CI，1.40-47.44；P=0.02）是不能再通的独立预测因素。同样，在基底动脉闭塞患者中，无房颤也是不能再通的独立预测因素（OR，7.50；95%CI，1.40-40.35；P=0.02）。
使用不能再通的相关预测因素和快速的血管神经评估可能有助于选择更积极的挽救性策略的患者。
