Dorado Laura, Arenillas Juan F, López-Cancio Elena, Hernández-Pérez María, Pérez de la Ossa Natalia, Gomis Meritxell, Millán Mònica, Granada María Luisa, Galán Amparo, Palomeras Ernest, Dávalos Antoni
Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
Stroke Unit, Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain.
J Stroke Cerebrovasc Dis. 2015 Nov;24(11):2605-12. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.015. Epub 2015 Sep 9.
Metabolic syndrome (MetS) has been associated with higher resistance to clot lysis at 24 hours after tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke. We aimed to test this hypothesis at earlier time points, when neurointerventional rescue procedures may still be indicated to achieve arterial recanalization.
This is a prospective and observational study in consecutive stroke patients with MCA occlusion treated with IV tPA. MetS was diagnosed following the unified criteria of the last Joint Interim Statement 2009 participating several major organizations. The primary outcome variable was resistance to thrombolysis, defined as the absence of complete middle cerebral artery recanalization 2 hours after tPA bolus assessed by transcranial color-coded duplex or when rescue mechanical thrombectomy after IV tPA was required. Secondary outcome variables were dramatic neurological improvement (decrease in ≥10 points, or a National Institutes of Health Stroke Scale [NIHSS] score of 0-1 at 24 hours), symptomatic intracerebral hemorrhage following European-Australasian Acute Stroke Study II criteria, infarct volume at 24 hours (calculated by using the formula for irregular volumes, ABC/2), and good outcome (modified Rankin Scale score < 3) at 3 months.
A total of 234 patients (median baseline NIHSS score 16 [10-20]) were included and 146 (62.4%) fulfilled MetS criteria. After multivariate analysis, MetS emerged as an independent predictor of resistance to thrombolysis (odds ratio = 2.2 [1.3-4.2], P = .01) and absence of dramatic neurological improvement (odds ratio = .5 [.28-.97], P = .04). In addition, MetS conferred poorer functional outcome, higher symptomatic intracerebral hemorrhage rate, and increased infarct volume, although these associations disappeared after adjustment for covariates.
MetS predicts patients with middle cerebral artery occlusion refractory to early clot dissolution after IV tPA. This finding may help in acute clinical decision-making.
代谢综合征(MetS)与急性缺血性脑卒中患者在给予组织型纤溶酶原激活剂(tPA)后24小时的血栓溶解抵抗性较高有关。我们旨在在更早的时间点验证这一假设,此时可能仍需进行神经介入抢救程序以实现动脉再通。
这是一项对连续接受静脉tPA治疗的大脑中动脉闭塞性脑卒中患者进行的前瞻性观察研究。根据2009年最后一份联合临时声明的统一标准诊断MetS,该声明由多个主要组织参与制定。主要结局变量为溶栓抵抗,定义为在推注tPA后2小时经颅彩色编码双功超声评估大脑中动脉未完全再通,或在静脉tPA治疗后需要进行补救性机械取栓时。次要结局变量包括显著的神经功能改善(24小时时下降≥10分,或美国国立卫生研究院卒中量表[NIHSS]评分为0 - 1分)、按照欧洲 - 澳大利亚急性脑卒中研究II标准的症状性脑出血、24小时时的梗死体积(使用不规则体积公式ABC/2计算)以及3个月时的良好结局(改良Rankin量表评分<3)。
共纳入234例患者(基线NIHSS评分中位数为16[10 - 20]),其中146例(62.4%)符合MetS标准。多因素分析后,MetS成为溶栓抵抗(比值比 = 2.2[1.3 - 4.2],P = 0.01)和无显著神经功能改善(比值比 = 0.5[0.28 - 0.97],P = 0.04)的独立预测因素。此外,MetS导致功能结局较差、症状性脑出血率较高以及梗死体积增大,尽管在对协变量进行调整后这些关联消失。
MetS可预测静脉tPA治疗后大脑中动脉闭塞患者早期血栓溶解难治性。这一发现可能有助于急性临床决策。