He Anna H, Churilov Leonid, Mitchell Peter J, Dowling Richard J, Yan Bernard
Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Vic., Australia.
Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia.
Int J Stroke. 2015 Oct;10(7):1062-7. doi: 10.1111/ijs.12495. Epub 2015 Apr 28.
Intra-arterial therapy has improved recanalization rates compared with intravenous thrombolysis for acute ischemic stroke; however, superior clinical efficacy has not been convincingly demonstrated. Time to recanalization is postulated as a mechanism hindering the efficacy of intra-arterial therapy.
To investigate the effects of time to recanalization on clinical outcome postintra-arterial therapy for acute ischemic stroke.
Clinical data were collected prospectively for consecutive patients undergoing intra-arterial therapy for acute ischemic stroke at a single center between 2009 and 2013. Ninety-day functional outcome was assessed by the modified Rankin scale. Univariate analyses identified candidate clinical variables for inclusion in the multivariable model; multivariable logistic regression analyses identified variables independently associated with good outcome, defined as modified Rankin scale 0-2.
One hundred and seven patients were included in the analysis. Median (interquartile range) age was 67 (54-77) years, 41 (38%) were female, and median (interquartile range) baseline National Institute of Health Stroke Severity score was 18 (13-22). Median time from symptom onset to recanalization was 330 min (interquartile range 277-397). Fifty-four (50%) patients achieved a favorable modified Rankin scale at 90 days. Age, successful recanalization, and time to recanalization were independently associated with good outcome at 90 days in multivariable logistic regression analysis. For every 15 min delay in recanalization, the odds of good outcome decreased by 10%.
Longer time to recanalization was associated with poorer functional outcome post intra-arterial therapy. We recommend that a systematic approach to minimize time delay to treatment is warranted in intra-arterial therapy for acute ischemic stroke.
与急性缺血性卒中的静脉溶栓治疗相比，动脉内治疗提高了再通率；然而，其卓越的临床疗效尚未得到令人信服的证实。再通时间被认为是阻碍动脉内治疗疗效的一个机制。
探讨急性缺血性卒中动脉内治疗后再通时间对临床结局的影响。
前瞻性收集2009年至2013年在单中心接受急性缺血性卒中动脉内治疗的连续患者的临床资料。采用改良Rankin量表评估90天功能结局。单因素分析确定纳入多变量模型的候选临床变量；多变量逻辑回归分析确定与良好结局独立相关的变量，良好结局定义为改良Rankin量表评分为0 - 2分。
107例患者纳入分析。年龄中位数（四分位间距）为67（54 - 77）岁，女性41例（38%），基线美国国立卫生研究院卒中严重程度评分中位数（四分位间距）为18（13 - 22）。从症状发作到再通的中位时间为330分钟（四分位间距277 - 397）。54例（50%）患者在90天时获得了良好的改良Rankin量表评分。在多变量逻辑回归分析中，年龄、成功再通和再通时间与90天时的良好结局独立相关。再通每延迟15分钟，良好结局的几率下降10%。
动脉内治疗后，再通时间越长，功能结局越差。我们建议在急性缺血性卒中的动脉内治疗中，应采取系统方法尽量减少治疗时间延迟。
