Jeong Hye Seon, Kwon Hyun-Jo, Kang Chang Woo, Song Hee-Jung, Koh Hyeon Song, Park Sang Min, Lim Jung Geol, Shin Ji Eun, Lee Suk Hoon, Kim Jei
Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurology, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea; Department of Neurosurgery, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea.
J Stroke Cerebrovasc Dis. 2014 Apr;23(4):e283-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.008. Epub 2014 Feb 12.
In acute ischemic stroke, the speed of improvement after intra-arterial thrombolytic therapy (IAT)-mediated recanalization varies. This study aimed to identify clinical and radiological variables that are predictive of early improvement (EI) after IAT in acute ischemic stroke.
This single-center retrospective cohort study included 141 consecutive patients who underwent IAT for terminal internal carotid and/or middle cerebral artery (MCA) occlusions. EI was defined as a National Institutes of Health Stroke Scale (NIHSS) score less than 3 or NIHSS score improvement of 8 points or more within 72 hours of IAT. The EI and non-EI groups were compared in terms of clinical and radiological findings before and after IAT.
Forty-nine patients showed EI (34.8%). Multivariate analysis revealed that atrial fibrillation (odds ratio [OR] .35, 95% confidence interval [CI] .14-.89, P = .028) and hyperdense MCA sign (OR .39, CI .15-.97, P = .042) were related with lack of EI. The independent EI predictors were less extensive parenchymal lesion on baseline computed tomography (OR 4.92, CI 1.74-13.9, P = .003), intermediate to good collaterals (OR 3.28, CI 1.16-9.31, P = .026), and recanalization within 6 hours of symptom onset (OR 5.2, CI 1.81-14.94, P = .002). EI associated with favorable outcomes (modified Rankin scale score 0-2) at discharge (88% versus 7%; P < .001) and 3 months after discharge (92% versus 18%; P < .001).
The clinical and radiological variables maybe useful for predicting EI and favorable long-term outcomes after IAT.
在急性缺血性卒中中，动脉内溶栓治疗（IAT）介导的血管再通后的改善速度各不相同。本研究旨在确定可预测急性缺血性卒中IAT后早期改善（EI）的临床和影像学变量。
这项单中心回顾性队列研究纳入了141例因颈内动脉末端和/或大脑中动脉（MCA）闭塞而接受IAT的连续患者。EI定义为在IAT后72小时内美国国立卫生研究院卒中量表（NIHSS）评分低于3分或NIHSS评分改善8分或更多。对EI组和非EI组在IAT前后的临床和影像学表现进行比较。
49例患者表现出EI（34.8%）。多变量分析显示，心房颤动（优势比[OR]0.35，95%置信区间[CI]0.14 - 0.89，P = 0.028）和MCA高密度征（OR 0.39，CI 0.15 - 0.97，P = 0.042）与缺乏EI相关。独立的EI预测因素为基线计算机断层扫描上实质病变范围较小（OR 4.92，CI 1.74 - 13.9，P = 0.003）、侧支循环中等至良好（OR 3.28，CI 1.16 - 9.31，P = 0.
