Sobolewski Piotr, Brola Waldemar, Wiszniewska Małgorzata, Szczuchniak Wiktor, Fudala Małgorzata, Domagalski Mariusz, Sledzińska-Dźwigał Monika
Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
Department of Neurology and Stroke Unit, Saint Luke's Hospital in Końskie, Końskie, Poland.
J Neurol Sci. 2014 May 15;340(1-2):44-9. doi: 10.1016/j.jns.2014.02.022. Epub 2014 Feb 26.
Intravenous thrombolysis (iv-thrombolysis) with the use of rt-PA in patients after recent transient ischemic attack (TIA) is an important clinical problem. The aim of the study was to assess the impact of TIA within 24h preceding acute ischemic stroke (AIS) on the safety and efficacy of iv-thrombolysis.
We retrospectively evaluated the clinical and demographic data of 400 patients with AIS who were consecutively treated with iv-thrombolysis from September 2006 to May 2011 in three stroke centers.
At three-month follow-up, 58.0% of patients were independent (modified Rankin scale; mRS 0-2), 17.8% had died, 17.0% suffered hemorrhagic transformation (HT) and 4.3% experienced symptomatic intracerebral hemorrhage (SICH). There were 29 patients (7.3%) who had a previous ipsilateral TIA within 24h before established stroke. In the TIA subgroup, there was no significant higher percentage of favorable outcome (p=0.07) and higher SICH rate (p=0.15). Multivariate analysis showed the impact of prior TIA within 24h before stroke onset in the presence of SICH (p=0.01), no impact of TIA on unfavorable outcomes after three months (p=0.25) and on the mortality rate within three months (p=0.41).
TIA within 24h prior to ischemic stroke can portend severe intracerebral bleeding in patients qualified to iv-thrombolysis with the use of rt-PA.
近期短暂性脑缺血发作（TIA）患者使用重组组织型纤溶酶原激活剂（rt-PA）进行静脉溶栓是一个重要的临床问题。本研究的目的是评估急性缺血性卒中（AIS）前24小时内TIA对静脉溶栓安全性和有效性的影响。
我们回顾性评估了2006年9月至2011年5月在三个卒中中心连续接受静脉溶栓治疗的400例AIS患者的临床和人口统计学数据。
在三个月的随访中，58.0%的患者独立生活（改良Rankin量表；mRS 0-2），17.8%的患者死亡，17.0%的患者发生出血性转化（HT），4.3%的患者发生症状性脑出血（SICH）。有29例患者（7.3%）在确诊卒中前24小时内有同侧TIA病史。在TIA亚组中，良好结局的比例没有显著升高（p=0.07），SICH发生率也没有显著升高（p=0.15）。多变量分析显示，卒中发作前24小时内既往TIA对SICH的发生有影响（p=0.01），对三个月后的不良结局没有影响（p=0.25），对三个月内的死亡率也没有影响（p=0.41）。
缺血性卒中前24小时内的TIA可能预示着使用rt-PA进行静脉溶栓的患者会发生严重的脑出血。
