Zhu Wusheng, Churilov Leonid, Campbell Bruce C V, Lin Monica, Liu Xinfeng, Davis Stephen M, Yan Bernard
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Royal Melbourne Institute of Technology University, Melbourne, Victoria, Australia.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2888-2893. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.018. Epub 2014 Oct 16.
Large vessel occlusion (LVO) is associated with poor functional outcome in acute ischemic stroke. Given the uncertainty whether LVO has the same significance in mild and severe stroke, we compared functional outcomes after intravenous thrombolysis, based on severity and LVO.
Ischemic stroke patients were thrombolyzed in less than 4.5 hours after onset between 2007 and 2013. LVO was defined as occlusion of one of the following arteries: internal carotid, middle cerebral (M1/M2), anterior cerebral (A1), posterior cerebral (P1), basilar, or vertebral (V4) arteries on prethrombolysis computed tomography angiography. Mild stroke was defined as baseline National Institutes of Health Stroke Scale (NIHSS) score 0-6. Favorable outcome was defined as modified Rankin Scale (mRS) score 0-1 at 3 months or equal to the prestroke mRS.
There were 175 acute stroke patients, median age 74 years (interquartile range [IQR], 64-83), median baseline NIHSS = 11 (IQR, 5-16), and 63 of 175 patients (36%) with mild stroke. LVO was associated with worse outcome in severe stroke (age-adjusted odds ratio [OR] of favorable outcome, .42; 95% confidence interval [CI], .19-.93; P = .033) and mortality (age-adjusted OR, 3.52; 95% CI, 1.08-11.48; P = .037). Although the difference in favorable outcome between mild stroke patients with and without LVO was not significant (55.6% vs. 74.1%, P = .262; age-adjusted OR of favorable outcome, .42; 95% CI, .1-1.84; P = .251), the similarity of effects across both subgroups cannot be excluded (LVO-by-stroke severity interaction test, P = .906).
LVO is associated with worse functional outcome and mortality in severe stroke after intravenous thrombolysis. Although significant association between LVO and outcome in mild stroke was not found, there were similar effects on outcome and a larger study might well confirm a relationship.
大血管闭塞（LVO）与急性缺血性卒中的不良功能预后相关。鉴于LVO在轻度和重度卒中中是否具有相同意义尚不确定，我们根据严重程度和LVO情况比较了静脉溶栓后的功能预后。
对2007年至2013年发病后4.5小时内接受溶栓治疗的缺血性卒中患者进行研究。LVO定义为溶栓前计算机断层扫描血管造影显示以下动脉之一闭塞：颈内动脉、大脑中动脉（M1/M2）、大脑前动脉（A1）、大脑后动脉（P1）、基底动脉或椎动脉（V4）。轻度卒中定义为基线美国国立卫生研究院卒中量表（NIHSS）评分0 - 6分。良好预后定义为3个月时改良Rankin量表（mRS）评分0 - 1分或与卒中前mRS评分相同。
共有175例急性卒中患者，中位年龄74岁（四分位间距[IQR]，64 - 83岁），中位基线NIHSS = 11分（IQR，5 - 16分），175例患者中有63例（36%）为轻度卒中。LVO与重度卒中的较差预后（良好预后的年龄校正优势比[OR]，0.42；95%置信区间[CI]，0.19 - 0.93；P = 0.033）和死亡率（年龄校正OR，3.52；95% CI，1.08 - 11.48；P = 0.037）相关。虽然轻度卒中伴有和不伴有LVO的患者在良好预后方面的差异不显著（55.6%对74.1%，P = 0.262；良好预后的年龄校正OR，0.42；95% CI，0.1 - 1.84；P = 0.251），但不能排除两个亚组效应的相似性（LVO与卒中严重程度交互作用检验，P = 0.906）。
LVO与静脉溶栓后重度卒中的较差功能预后和死亡率相关。虽然未发现LVO与轻度卒中预后之间存在显著关联，但对预后有相似影响，更大规模的研究可能会证实两者之间的关系。
