Department of Clinical Neuroscience, King's College London, UK.
Stroke. 2013 Aug;44(8):2226-31. doi: 10.1161/STROKEAHA.111.000757. Epub 2013 May 30.
Wake-up ischemic stroke (WUIS) patients are not thrombolysed even if they meet other criteria for treatment. We hypothesized that patients with WUIS showing no or early ischemic changes on brain imaging will have thrombolysis outcomes comparable with those with known time of symptom onset.
Consecutive sampling of a prospective registry of patients with stroke between January 2009 and December 2010 identified 394 thrombolysed patients meeting predefined inclusion criteria, 326 presenting within 0 to 4.5 hours of symptom onset (Reference Group) and 68 WUIS patients. Inclusion criteria were last seen normal<12 hours or >4.5 hours (WUIS) or presented <4.5 hours (Reference Group), had National Institutes of Health Stroke Scale score ≥5, and no or early ischemic changes on imaging at presentation. The primary outcome measure was the modified Rankin Scale of 0 to 2 at 90 days measured by trained assessors blinded to patient grouping. Other outcome measures were symptomatic intracerebral hemorrhage, modified Rankin Scale 0 to 1, and mortality at 90 days.
The groups were comparable for mean age (72.8 versus 73.9 years; P=0.58) and baseline median National Institutes of Health Stroke Scale score (median 13 versus 12; P=0.34). The proportions of patients with modified Rankin Scale 0 to 2 (38% versus 37%; P=0.89) and modified Rankin Scale 0 to 1 (24% versus 16%; P=0.18) at 90 days, any ICH (20% versus 22%; P=0.42) and symptomatic intracerebral hemorrhage (3.4% versus 2.9%; P=1.0) were comparable after adjusting for age, stroke severity, and imaging changes. Only 9/394 (2%) patients were lost to follow-up.
Thrombolysis in selected patients with WUIS is feasible, and its outcomes are comparable with those thrombolysed with 0 to 4.5 hours.
即使符合其他治疗标准，觉醒性缺血性卒中（WUIS）患者也未进行溶栓治疗。我们假设在影像学上显示无或早期缺血改变的 WUIS 患者，其溶栓治疗结局与已知症状发作时间的患者相当。
连续纳入 2009 年 1 月至 2010 年 12 月期间一项前瞻性卒中登记研究中的患者，共 394 例溶栓患者符合预先设定的纳入标准，其中 326 例起病 0 至 4.5 小时内（参照组），68 例为 WUIS 患者。纳入标准为最后一次见到正常时间<12 小时或>4.5 小时（WUIS）或起病<4.5 小时（参照组）、美国国立卫生研究院卒中量表评分≥5 分，且影像学上无或仅有早期缺血改变。主要结局测量指标为 90 天时由训练有素的评估者进行的改良 Rankin 量表评分 0 至 2 分（通过盲法评估患者分组）。其他结局测量指标包括症状性颅内出血、改良 Rankin 量表 0 至 1 分和 90 天死亡率。
两组平均年龄（72.8 岁与 73.9 岁；P=0.58）和基线中位数美国国立卫生研究院卒中量表评分（中位数 13 分与 12 分；P=0.34）相似。90 天时改良 Rankin 量表评分 0 至 2 分的患者比例（38%与 37%；P=0.89）和改良 Rankin 量表评分 0 至 1 分的患者比例（24%与 16%；P=0.18）、任何颅内出血（20%与 22%；P=0.42）和症状性颅内出血（3.4%与 2.9%；P=1.0）在调整年龄、卒中严重程度和影像学改变后相似。仅 9/394（2%）例患者失访。
在选择的 WUIS 患者中进行溶栓治疗是可行的，其结局与 0 至 4.5 小时内溶栓治疗的患者相当。
