Kahles Timo, Mono Marie-Luise, Heldner Mirjam Rachel, Baumgartner Ralf Werner, Sarikaya Hakan, Luft Andreas, Bohlhalter Stephan, Traenka Christopher, Engelter Stefan T, Kurka Natalia, Köhrmann Martin, Curtze Sami, Michel Patrik, Tatlisumak Turgut, Nedeltchev Krassen
From the Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland (T.K., K.N.); Inselspital, University Hospital and University of Bern, Bern, Switzerland (M.-L.M., M.R.H., H.S.); Hirslanden Hospital Zurich, Zurich, Switzerland (R.W.B.); University Hospital Zurich, Zurich, Switzerland (A.L.); Cantonal Hospital Lucerne, Lucerne, Switzerland (S.B.); University Hospital Basel, Basel, Switzerland (C.T., S.T.E.); Universitätsklinikum Erlangen, Erlangen, Germany (N.K., M.K.); Helsinki University Central Hospital, Helsinki, Finland (S.C., T.T.); Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and University Hospital Lausanne CHUV, Lausanne, Switzerland (P.M.).
Stroke. 2016 Aug;47(8):2133-5. doi: 10.1161/STROKEAHA.116.013599. Epub 2016 Jun 30.
Intravenous thrombolysis (IVT) within 4.5 hours from symptom onset improves functional outcome in patients with acute ischemic stroke. Its use in patients with previous stroke within the preceding 3 months is contraindicated because of the assumed higher risk of intracranial hemorrhage. In addition, tissue-type plasminogen activator may itself promote neurotoxicity and blood-brain barrier disruption. However, safety and effectiveness of repeated IVT is essentially unknown in patients with early (<3 months) recurrent stroke (ERS), because they were excluded from thrombolysis trials. This article reports the largest case series of repeated IVT in ERS.
We reviewed databases of prospectively collected patient data of 8 European stroke centers for the presence of patients with ERS, who received IVT for both the index stroke and ERS. Demographics, clinical and radiological data, bleeding complications, and functional outcome were analyzed.
We identified 19 subjects with repeated IVT in ERS. Mean age was 68±12 years, and 37% of them were female. Median interthrombolysis interval was 30 days (interquartile range, 13-50). Functional independence (modified Rankin scale score ≤2) was achieved in 79% of patients after the first and in 47.4% after repeated IV tissue-type plasminogen activator, respectively. There was no symptomatic intracranial hemorrhage. Median final infarct volume after the first IVT was 1.5 cm(3) (interquartile range, 0.5-3.1).
Patients with small infarct volumes and robust clinical improvement might be considered for repeated IVT within 3 months. Studies following strict protocols and larger registries incorporating these patients might serve to identify selection criteria for the safe use of repeated IVT in ERS.
症状发作后4.5小时内进行静脉溶栓（IVT）可改善急性缺血性卒中患者的功能结局。由于颅内出血风险较高，在前3个月内有过卒中史的患者禁用IVT。此外，组织型纤溶酶原激活剂本身可能会促进神经毒性和血脑屏障破坏。然而，早期（<3个月）复发性卒中（ERS）患者重复IVT的安全性和有效性基本未知，因为他们被排除在溶栓试验之外。本文报告了ERS患者重复IVT的最大病例系列。
我们回顾了8个欧洲卒中中心前瞻性收集的患者数据数据库，以查找ERS患者，这些患者在首次卒中和ERS时均接受了IVT。分析了人口统计学、临床和放射学数据、出血并发症及功能结局。
我们确定了19例ERS患者接受了重复IVT。平均年龄为68±12岁，其中37%为女性。两次溶栓间隔的中位数为30天（四分位间距，13 - 50）。首次IVT后79%的患者和重复静脉注射组织型纤溶酶原激活剂后47.4%的患者实现了功能独立（改良Rankin量表评分≤2）。未出现症状性颅内出血。首次IVT后的最终梗死体积中位数为1.5 cm³（四分位间距，0.5 - 3.1）。
梗死体积小且临床改善明显的患者可考虑在3个月内进行重复IVT。遵循严格方案的研究以及纳入这些患者的更大规模登记研究可能有助于确定ERS患者安全使用重复IVT的选择标准。
