Seet Raymond C S, Wijdicks Eelco F M, Rabinstein Alejandro A
Arch Neurol. 2012 Dec;69(12):1615-20. doi: 10.1001/archneurol.2012.2569.
Previous studies have not distinguished patients with acute cervical internal carotid artery (ICA) occlusions from those with intracranial occlusions and often consider them together in the same cohort.
To evaluate the outcomes of patients with stroke from acute cervical ICA occlusion treated with intravenous thrombolysis or primary endovascular procedures and to identify early predictors of functional recovery among these patients.
Retrospective study.
Academic hospital.
We studied patients with ischemic stroke who received intravenous thrombolysis or endovascular treatment for acute cervical ICA occlusion at St Mary's Hospital, Mayo Clinic, Rochester, Minnesota. We evaluated the associations of vascular risk factors, severity of stroke, arterial recanalization, presence of tandem occlusions, and collateral distal flow with functional recovery at 90 days after stroke.
Favorable functional recovery (Modified Rankin Scale score, 0-2).
We identified 21 patients (median age, 67 years; median National Institutes of Health Stroke Scale score at presentation, 13), of whom 13 patients received intravenous thrombolysis and 8 patients underwent primary endovascular treatment. Three patients who received intravenous thrombolysis underwent rescue endovascular treatment. Favorable functional recovery (Modified Rankin Scale score, 0-2) was observed in 7 patients who received intravenous thrombolysis and in 1 patient who underwent primary endovascular treatment. Good collateral distal flow and intracranial tandem occlusions were observed in 6 patients and 12 patients, respectively. Good collateral distal flow, observed more frequently in cigarette smokers, was associated with favorable functional recovery (odds ratio, 20; 95% CI, 2-242; P = .02).
Intravenous thrombolysis should be administered as first-line treatment in patients with early acute cervical ICA occlusion. Treatment benefits are accentuated in patients with better collateral circulation.
既往研究未区分急性颈内动脉（ICA）闭塞患者与颅内闭塞患者，常将他们纳入同一队列进行研究。
评估接受静脉溶栓或初次血管内治疗的急性颈内动脉闭塞所致卒中患者的预后，并确定这些患者功能恢复的早期预测因素。
回顾性研究。
学术医院。
我们研究了在明尼苏达州罗切斯特市梅奥诊所圣玛丽医院接受静脉溶栓或血管内治疗的急性颈内动脉闭塞所致缺血性卒中患者。我们评估了血管危险因素、卒中严重程度、动脉再通、串联闭塞的存在以及侧支远端血流与卒中后90天功能恢复的相关性。
良好的功能恢复（改良Rankin量表评分，0 - 2分）。
我们纳入了21例患者（中位年龄67岁；就诊时美国国立卫生研究院卒中量表中位评分13分），其中13例患者接受了静脉溶栓，8例患者接受了初次血管内治疗。3例接受静脉溶栓的患者接受了补救性血管内治疗。接受静脉溶栓的7例患者和接受初次血管内治疗的1例患者观察到良好的功能恢复（改良Rankin量表评分，0 - 2分）。分别在6例和12例患者中观察到良好的侧支远端血流和颅内串联闭塞。在吸烟者中更常观察到的良好侧支远端血流与良好的功能恢复相关（比值比，20；95%可信区间，2 - 242；P = 0.02）。
对于早期急性颈内动脉闭塞患者，应将静脉溶栓作为一线治疗。侧支循环较好的患者治疗获益更明显。
