Ng Felix C, Coote Skye, Frost Tanya, Bladin Chris, Choi Philip M
From the Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia (F.C.N., S.C., T.F., C.B., P.M.C.); and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia (C.B., P.M.C.).
Stroke. 2016 Jul;47(7):1914-6. doi: 10.1161/STROKEAHA.116.013021. Epub 2016 May 19.
The use of thrombolysis in acute minor ischemic stroke (MIS) remains controversial. We sought to determine the safety and efficacy of intravenous tissue-type plasminogen activator (IV-tPA) in acute MIS patients with demonstrable penumbra on computed tomographic perfusion study.
Consecutive MIS patients with National Institutes of Health Stroke Scale ≤3 were identified from a prospective single tertiary-center database over a 4.5-year period (2011-2015). Cases with demonstrable penumbra were analyzed according to treatment received: IV-tPA versus standard stroke-unit care without thrombolysis.
Seventy-three patients of 195 acute MIS admissions had a demonstrable penumbra (34 IV-tPA versus 39 standard stroke-unit care). Overall median National Institutes of Health Stroke Scale and premorbid modified Rankin Scale were 2 and 0, respectively. Median age was 73.2 (interquartile range, 67.3-82.8) years. There were no differences in baseline demographics, risk factors, stroke localization and cause, rates of vascular occlusion (38.2% versus 38.5%; P=1.000), or mean penumbral volume (41.3 versus 25.1 mL; P=0.150; IV-tPA versus standard stroke-unit care) between groups. There were no symptomatic intracerebral hemorrhages in either group. Patients treated with IV-tPA were more likely to have an excellent functional outcome at discharge (88.2% versus 53.9%; P=0.002) and 90 days (91.2% versus 71.8%; P=0.042). Ordinal analysis demonstrated a favorable shift in modified Rankin Scale with IV-tPA both at discharge (odds ratio, 5.23; 95% confidence interval, 1.83-12.20) and 90 days (odds ratio, 4.35; 95% confidence interval, 1.77-11.36).
In selected MIS patients with demonstrable penumbra on computed tomographic perfusion, IV-tPA is safe and associated with significant improvement in functional outcome at discharge and 90 days.
急性轻度缺血性卒中（MIS）中溶栓治疗的应用仍存在争议。我们旨在确定静脉注射组织型纤溶酶原激活剂（IV-tPA）在计算机断层扫描灌注研究中有明确半暗带的急性MIS患者中的安全性和有效性。
在4.5年期间（2011 - 2015年），从一个前瞻性单三级中心数据库中识别出美国国立卫生研究院卒中量表评分≤3的连续MIS患者。根据接受的治疗对有明确半暗带的病例进行分析：IV-tPA治疗与不进行溶栓的标准卒中单元护理。
195例急性MIS入院患者中有73例有明确半暗带（34例接受IV-tPA治疗，39例接受标准卒中单元护理）。总体美国国立卫生研究院卒中量表中位数和病前改良Rankin量表中位数分别为2和0。中位年龄为73.2（四分位间距，67.3 - 82.8）岁。两组在基线人口统计学、危险因素、卒中定位和病因、血管闭塞率（38.2%对38.5%；P = 1.000）或平均半暗带体积（41.3对25.1 mL；P = 0.150；IV-tPA治疗组对标准卒中单元护理组）方面无差异。两组均未出现症状性脑出血。接受IV-tPA治疗的患者在出院时（88.2%对53.9%；P = 0.002）和90天时（91.2%对71.8%；P = 0.042）更有可能获得良好的功能结局。序贯分析表明，IV-tPA治疗在出院时（优势比，5.23；95%置信区间，1.83 - 12.20）和90天时（优势比，4.35；95%置信区间，1.77 - 11.36）均使改良Rankin量表出现有利变化。
在计算机断层扫描灌注中有明确半暗带的特定MIS患者中，IV-tPA是安全的，并且与出院时和90天时功能结局的显著改善相关。
