Hernández-Pérez María, Pérez de la Ossa Natalia, Aleu Aitziber, Millán Mònica, Gomis Meritxell, Dorado Laura, López-Cancio Elena, Jovin Tudor, Dávalos Antoni
Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
J Neuroimaging. 2014 Jul-Aug;24(4):354-8. doi: 10.1111/jon.12062. Epub 2013 Nov 19.
The natural history of acute ischemic stroke (AIS) due to anterior circulation large artery occlusion is not well established. This information is essential for assessment of clinical benefit derived from recanalization therapies.
Patients with AIS due to anterior circulation large artery occlusion not treated with reperfusion therapies admitted from January 2005 to September 2010 were consecutively selected. Site of occlusion was assessed with transcranial duplex according to Thrombolysis in Brain Infarction (TIBI) grades. Poor outcome was considered as a modified Rankin Scale>2 at 90 days.
A total of 120 patients were studied. Site of occlusion was terminal internal carotid artery (TICA) in 13 (10.8%), proximal middle cerebral artery (MCA) in 69 (57.5%), and distal MCA in 38 (31.7%) patients. Overall, 74.2% of patients had poor outcome. There were significant differences in poor outcome between patients with TICA, proximal MCA, and distal MCA occlusion (92%, 87%, 47%, P < .001) and mortality at 90 days (23%, 12%, 3%, P = .001).
Outcome of AIS patients with anterior circulation large artery occlusion not treated with reperfusion therapies is extremely poor in TICA and proximal MCA occlusions with better outcomes noted in distal MCA occlusions. These findings are relevant for estimation of treatment effect of reperfusion therapies according to occlusion location.
前循环大动脉闭塞所致急性缺血性卒中（AIS）的自然病程尚未完全明确。该信息对于评估再通治疗的临床获益至关重要。
连续选取2005年1月至2010年9月收治的未接受再灌注治疗的前循环大动脉闭塞所致AIS患者。根据脑梗死溶栓（TIBI）分级，采用经颅双功超声评估闭塞部位。不良预后定义为90天时改良Rankin量表评分>2分。
共研究了120例患者。闭塞部位为颈内动脉终末段（TICA）的有13例（10.8%），大脑中动脉近端（MCA）的有69例（57.5%），大脑中动脉远端的有38例（31.7%）。总体而言，74.2%的患者预后不良。TICA、MCA近端和MCA远端闭塞患者的不良预后（分别为92%、87%、47%，P <.001）及90天死亡率（分别为23%、12%、3%，P =.001）存在显著差异。
未接受再灌注治疗的前循环大动脉闭塞AIS患者中，TICA和MCA近端闭塞的预后极差，而MCA远端闭塞的预后较好。这些发现对于根据闭塞部位评估再灌注治疗的效果具有重要意义。
