Bernardini Gary L, Schellinger Peter D, Abou-Chebl Alex, Cockroft Kevin, Shuaib Ashfaq, Sheorajpanday Rishi, Sen Souvik, Diener Hans-Christoph, Leker Ronen R, Bornstein Natan M
Department of Neurology, Albany Medical College, Albany, New York.
Department of Neurology, Johannes Wesling Klinikum Minden, Minden, Germany.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1457-61. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.006. Epub 2014 Feb 12.
Atrial fibrillation (AF) is a well-established independent risk factor for stroke. We examined cerebral blood flow augmentation in the treatment of acute ischemic stroke (AIS) in patients with AF by performing secondary analysis of data from the Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS) trial, a randomized controlled trial evaluating NeuroFlo treatment in stroke patients within 14 hours of symptom onset. We report subgroup analyses of outcomes in SENTIS patients with a history or new diagnosis of AF. Among patients with AF, those treated with NeuroFlo demonstrated significant improvement over those not treated for multiple end points: global efficacy end point (P=.030), modified Rankin Scale (mRS) score 0-2 versus 3-6 (P=.029), and stroke-related mortality (P=.015). There was a significant improvement in global end point for those aged 60 years or older (P=.042) and 80 years or older (P=.017), with a trend toward improvement for age 70 years or older (P=.055), and significant improvement in those who achieved good outcomes (mRS score 0-2 versus 3-6) at age 60 years or older (P=.038), 70 years or older (P=.022), and 80 years or older (P=.008). NeuroFlo treatment in stroke patients with AF resulted in significantly better outcomes compared with nontreated patients with AF. Collateral flow recruitment, maintenance of cerebral blood flow around stroke core, and improvement of penumbral blood flow are potential mechanisms for these improved outcomes. NeuroFlo may represent a valid therapeutic option for patients with AF and AIS, and therefore, future trials of the device are warranted.
心房颤动（AF）是公认的中风独立危险因素。我们通过对缺血性中风神经流技术安全性和有效性（SENTIS）试验的数据进行二次分析，研究了AF患者急性缺血性中风（AIS）治疗中的脑血流增加情况，该试验是一项随机对照试验，评估症状发作14小时内中风患者的神经流治疗。我们报告了有AF病史或新诊断为AF的SENTIS患者的亚组结局分析。在AF患者中，接受神经流治疗的患者在多个终点方面比未接受治疗的患者有显著改善：总体疗效终点（P = 0.030）、改良Rankin量表（mRS）评分0 - 2与3 - 6（P = 0.029）以及中风相关死亡率（P = 0.015）。60岁及以上（P = 0.042）和80岁及以上（P = 0.017）患者的总体终点有显著改善，70岁及以上患者有改善趋势（P = 0.055），60岁及以上（P = 0.038）、70岁及以上（P = 0.022）和80岁及以上（P = 0.008）达到良好结局（mRS评分0 - 2与3 - 6）的患者有显著改善。与未治疗的AF患者相比，AF中风患者的神经流治疗产生了显著更好的结局。侧支血流募集、中风核心周围脑血流的维持以及半暗带血流的改善是这些改善结局的潜在机制。神经流可能是AF和AIS患者的一种有效治疗选择；因此，该设备的未来试验是有必要的。
