颈内动脉闭塞所致急性缺血性卒中的静脉溶栓治疗——塞尔维亚缺血性卒中溶栓治疗经验（SETIS）
Intravenous thrombolysis in acute ischemic stroke due to occlusion of internal carotid artery - a Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS).
作者信息
Zivanovic Zeljko, Gvozdenovic Slobodan, Jovanovic Dejana R, Lucic-Prokin Aleksandra, Sekaric Jelena, Lukic Sonja, Kokai-Zekic Timea, Zarkov Marija, Cvijanovic Milan, Beslac-Bumbasirevic Ljiljana, Slankamenac Petar
机构信息
Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia.
Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia.
出版信息
Clin Neurol Neurosurg. 2014 May;120:124-8. doi: 10.1016/j.clineuro.2014.03.008. Epub 2014 Mar 15.
OBJECTIVE
The benefit of intravenous thrombolysis in patients with internal carotid artery (ICA) occlusion is still unclear. The aim of this study was to assess the influence on outcome of intravenous thrombolysis in patients with ICA occlusion comparing to those without it.
METHODS
Data were from the national register of all acute ischemic stroke patients treated with intravenous thrombolysis in Serbia. Patients with nonlacunar anterior circulation infarction were included and were divided into two groups, those with and those without ICA occlusion. We compared the differences in demographic characteristics, risk factors, baseline NIHSS score, early neurological improvement, 3-month functional outcome, complications and death between these two groups.
RESULTS
Among 521 included patients there were 13.4% with ICA occlusion. Group with ICA occlusion had more males (82.9% vs. 60.5%; p=0.0008), and more severe stroke (baseline NIHSS score 15.3 vs. 13.6; p=0.004). Excellent functional outcome (mRS 0-1) at 3 months was recorded in 32.9% patients with ICA occlusion and in 50.6% patients without (p=0.009), while favorable functional outcome (mRS 0-2) was recorded in 50.0% of patients with ICA occlusion vs. 60.1% without (p=0.14). Death occurred in 12.9% patients with ICA occlusion and in 17.3% patients without it (p=0.40). There was no significant difference in rate of symptomatic ICH between the two groups (1.4% vs. 4.2%; p=0.5). Multivariate logistic regression analysis showed that ICA occlusion was associated with the absence of early neurological improvement (p=0.03; OR 1.78, 95% CI 1.05-3.04). However, the presence of ICA occlusion was not significantly associated with an unfavorable outcome at 3-month (p=0.44; OR 1.24, 95% CI 0.72-2.16) or with death (p=0.18; OR 0.57, 95% CI 0.25-1.29).
CONCLUSION
The patients with ICA occlusion treated with intravenous thrombolysis have a worse outcome than patients without it.
目的
颈内动脉（ICA）闭塞患者静脉溶栓的获益仍不明确。本研究旨在评估ICA闭塞患者静脉溶栓与未闭塞患者相比对预后的影响。
方法
数据来自塞尔维亚所有接受静脉溶栓治疗的急性缺血性卒中患者的国家登记册。纳入非腔隙性前循环梗死患者，并分为两组，即有和无ICA闭塞的患者。我们比较了这两组在人口统计学特征、危险因素、基线美国国立卫生研究院卒中量表（NIHSS）评分、早期神经功能改善、3个月功能结局、并发症和死亡方面的差异。
结果
在521例纳入患者中，13.4%存在ICA闭塞。ICA闭塞组男性更多（82.9%对60.5%；p = 0.0008），且卒中更严重（基线NIHSS评分15.3对13.6；p = 0.004）。3个月时，32.9%的ICA闭塞患者记录到良好的功能结局（改良Rankin量表[mRS] 0 - 1），未闭塞患者为50.6%（p = 0.009），而50.0%的ICA闭塞患者记录到有利的功能结局（mRS 0 - 2），未闭塞患者为60.1%（p = 0.14）。12.9%的ICA闭塞患者死亡，未闭塞患者为17.3%（p = 0.40）。两组间症状性颅内出血发生率无显著差异（1.4%对4.2%；p = 0.5）。多因素逻辑回归分析显示，ICA闭塞与早期神经功能改善缺失相关（p = 0.03；比值比[OR] 1.78，95%置信区间[CI] 1.05 - 3.04）。然而，ICA闭塞的存在与3个月时不良结局（p = 0.44；OR 1.24，95% CI 0.72 - 2.16）或死亡（p = 0.18；OR 0.57，95% CI 0.25 - 1.29）无显著关联。
结论
接受静脉溶栓治疗的ICA闭塞患者的预后比未闭塞患者差。
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