急性缺血性脑卒中患者对静脉组织型纤溶酶原激活剂无反应时的额外血管内治疗：磁共振血管造影-弥散不匹配的作用。
Additional endovascular therapy in patients with acute ischemic stroke who are nonresponsive to intravenous tissue plasminogen activator: usefulness of magnetic resonance angiography-diffusion mismatch.
机构信息
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
出版信息
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):1056-63. doi: 10.1016/j.jstrokecerebrovasdis.2012.07.002. Epub 2012 Aug 15.
BACKGROUND
In patients who are not responsive to intravenous tissue plasminogen activator (IV t-PA), the present study aimed to report recanalization rates, the incidence of hemorrhagic transformation (HT), and clinical outcomes of additional endovascular therapy (AET), and to investigate the usefulness of magnetic resonance angiography-diffusion mismatch (MDM) in a selection of patients eligible for AET.
METHODS
Fifty-eight patients who received IV t-PA therapy because of intracranial major artery occlusion between April 2007 and November 2010 were divided into 2 groups: 18 patients in the AET group and 21 patients in the IV t-PA nonresponders group. The remaining 19 patients were responders to IV t-PA and therefore not eligible for this study. Recanalization rates, HT incidence, and 3-month outcomes were assessed, and the relationship between MDM and clinical outcome was examined.
RESULTS
A 3-month modified Rankin Scale (mRS) score of 0 to 3 was seen more frequently in the AET group (72% in the AET group v 29% in the nonresponder group; P = .01). Serious outcomes (3-month mRS of 5-6) were seen significantly less often in the AET group (17%) than in the nonresponder group (57%; P = .019). There were no differences in the incidence of HT. In the AET group, reappraisal considering MDM revealed a significantly higher rate of a 3-month mRS of 0 to 3 in the MDM-positive group compared to the MDM-negative group (86% v 25%, respectively; P = .044). Serious outcomes were observed significantly less frequently in the MDM-positive group compared to the MDM-negative group (0% v 75%, respectively; P = .005).
CONCLUSIONS
AET for nonresponders to IV t-PA was safe, improved recanalization rates, and led to better prognoses. MDM was a very good predictor of improved prognosis in a selection of eligible patients for AET after IV t-PA.
背景
在对静脉注射组织型纤溶酶原激活剂（IV t-PA）无反应的患者中，本研究旨在报告血管内治疗（AET）的再通率、出血转化（HT）发生率和临床结局，并探讨磁共振血管造影-弥散不匹配（MDM）在选择适合 AET 的患者中的应用价值。
方法
2007 年 4 月至 2010 年 11 月，58 例颅内大血管闭塞患者接受 IV t-PA 治疗，分为 AET 组（18 例）和 IV t-PA 无反应组（21 例）。其余 19 例患者对 IV t-PA 有反应，因此不符合本研究条件。评估再通率、HT 发生率和 3 个月结局，并检查 MDM 与临床结局的关系。
结果
AET 组 3 个月改良 Rankin 量表（mRS）评分 0-3 分的比例更高（AET 组 72%，无反应组 29%；P=0.01）。AET 组严重结局（3 个月 mRS 5-6 分）的比例明显低于无反应组（17%比 57%；P=0.019）。HT 发生率无差异。在 AET 组，重新评估考虑 MDM 后，MDM 阳性组 3 个月 mRS 评分 0-3 分的比例明显高于 MDM 阴性组（86%比 25%；P=0.044）。MDM 阳性组严重结局的比例明显低于 MDM 阴性组（0%比 75%；P=0.005）。
结论
IV t-PA 无反应患者的 AET 是安全的，可提高再通率，改善预后。MDM 是 IV t-PA 后选择适合 AET 的患者中，预测预后改善的一个非常好的指标。
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