Lyerly Michael J, Houston J Thomas, Boehme Amelia K, Albright Karen C, Bavarsad Shahripour Reza, Palazzo Paola, Alvi Muhammed, Rawal Pawan V, Kapoor Niren, Sisson April, Alexandrov Anne W, Alexandrov Andrei V
Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham Veterans Administration Medical Center, Birmingham, Alabama.
Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1657-61. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.011. Epub 2014 Mar 28.
Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA).
We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition.
Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P=.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P=.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P=.221) or any HT (18% versus 14%; P=.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P<.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P=.065).
Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.
3个月内曾患中风会使患者被排除在溶栓治疗之外；然而，患者可能有既往梗死的计算机断层扫描（CT）证据，且梗死发生时间往往不明。我们旨在确定静脉注射（IV）组织型纤溶酶原激活剂（tPA）前CT上存在既往梗死灶是否可预测出血性并发症及功能结局。
我们回顾性分析了2009年至2011年在我院接受IV tPA治疗的连续患者。对治疗前CT进行回顾，以寻找既往梗死的证据。进一步检查以确定重复CT或磁共振成像上是否存在任何出血性转化（HT）或症状性脑出血（sICH）。结局指标包括sICH、任何HT、功能结局不良（改良Rankin量表评分为4 - 6分）及出院处置情况。
在212例接受IV tPA治疗的患者中，84例（40%）在治疗前CT上有既往梗死的证据。CT上有既往梗死灶的患者年龄更大（中位年龄，72岁对65岁；P = 0.001），治疗前美国国立卫生研究院卒中量表评分更高（中位值，10分对7分；P = 0.023）。CT上有既往梗死灶的患者发生sICH的比例并不更高（4%对2%；P = 0.221），发生任何HT的比例也不更高（18%对14%；P = 0.471）。这些患者出院时功能结局不良的发生率更高（82%对50%；P < 0.001），出院回家或入住 inpatient rehabilitation center（此处原文可能有误，推测应为“住院康复中心”）的比例更低（61%对73%；P = 0.065）。
在我们的研究中，治疗前CT上既往梗死灶的显示并未预测sICH风险增加，且在排除3个月内临床明确的中风后，不应将其视为拒绝全身性tPA治疗的理由。
