Aghaebrahim Amin, Leiva-Salinas Carlos, Jadhav Ashutosh P, Jankowitz Brian, Zaidi Syed, Jumaa Mouhammad, Urra Xabi, Amorim Edilberto, Zhu Guangming, Giurgiutiu Dan-Victor, Horev Anat, Reddy Vivek, Hammer Maxim, Wechsler Lawrence, Wintermark Max, Jovin Tudor
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Neuroradiology Division, Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
J Neurointerv Surg. 2015 Dec;7(12):875-80. doi: 10.1136/neurintsurg-2014-011316. Epub 2014 Oct 17.
Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW).
A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment.
We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38%, n=78) and (2) patients with witnessed onset beyond 8 h (62%, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43% vs. 50%, p=0.3), parenchymal hematoma (9% vs. 5.5%, p=0.3), and final infarct volume (75.2 vs. 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95% CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95% CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes.
Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.
既往研究表明，与血管再通时起病时间较晚且有目击者的患者相比，醒后卒中（WUS）患者可能有更好的预后。我们试图在末次正常时间（TLSW）超过8小时后接受血管内治疗的前循环大血管闭塞性卒中（ACLVOS）患者中验证这一假设。
对一个前瞻性收集的连续患者数据库进行单中心回顾性分析，以确定TLSW超过8小时、有ACLVOS影像学证据、梗死核心小且半暗带大且随后接受血管内治疗的患者。
我们纳入了206例患者。患者分为两组：（1）WUS患者（38%，n = 78）和（2）起病时间超过8小时且有目击者的患者（62%，n = 128）。两组在年龄、基线美国国立卫生研究院卒中量表评分、TLSW至再灌注时间、基线梗死体积和成功再通率方面相似。良好预后率（90天时改良Rankin量表评分为0 - 2分，43%对50%，p = 0.3）、实质内血肿发生率（9%对5.5%，p = 0.3）和最终梗死体积（75.2对61.4 mL，p = 0.6）相当。多因素分析确定年龄（OR = 0.95，95%CI 0.91至0.99，p < 0.042）、成功再通（OR 6.0，95%CI 1.5至23.5，p = 0.009）和最终梗死体积（OR 0.98，95%CI 0.97至0.99，p < 0.001）是良好预后的预测因素，而起病方式不是。
与起病时间超过8小时且有目击者的患者相比，WUS患者血管内治疗后的良好预后率、实质内血肿发生率和最终梗死体积可能无差异。
