识别伴有大脑前大血管闭塞的缺血性中风患者的临床选择策略：来自SITS-ISTR（国际中风溶栓注册研究中溶栓的安全实施）的结果
Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry).
作者信息
Scheitz Jan F, Abdul-Rahim Azmil H, MacIsaac Rachael L, Cooray Charith, Sucharew Heidi, Kleindorfer Dawn, Khatri Pooja, Broderick Joseph P, Audebert Heinrich J, Ahmed Niaz, Wahlgren Nils, Endres Matthias, Nolte Christian H, Lees Kennedy R
机构信息
From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.).
出版信息
Stroke. 2017 Feb;48(2):290-297. doi: 10.1161/STROKEAHA.116.014431. Epub 2017 Jan 13.
BACKGROUND AND PURPOSE
The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies.
METHODS
Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012-May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery).
RESULTS
Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8-5.3). All 3 face-arm-speech-time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity.
CONCLUSIONS
Simple modification of the face-arm-speech-time score or evaluating the NIHSS symptom profile may help to stratify patients' risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required.
背景与目的
美国国立卫生研究院卒中量表（NIHSS）与大脑前大血管闭塞（LAVO）的存在相关。然而，在院前环境中应用完整的NIHSS来选择适合进行血栓切除术治疗的患者存在局限性。因此，我们旨在评估简单临床选择策略的预后价值。
方法
回顾性分析国际卒中溶栓注册研究中卒中溶栓安全实施项目（2012年1月至2014年5月）的数据。纳入NIHSS评分完整且有记录的血管状况的患者。我们评估了院前卒中量表和NIHSS症状特征与LAVO（颈内动脉、颈动脉末端或大脑中动脉M1段）的关联。
结果
在3505例患者中，23.6%（n = 827）存在LAVO。NIHSS项目最佳凝视的病理表现与LAVO密切相关（调整优势比4.5，95%置信区间3.8 - 5.3）。所有三项面-臂-言语-时间测试（FAST）项目识别LAVO的敏感性都很高。将凝视项目添加到原始FAST评分中（G-FAST）或其他简化卒中量表的高分可提高特异性。代表完全前循环综合征的NIHSS症状特征显示LAVO的可能性比非特异性临床特征增加了10倍。与NIHSS阈值≥6相比，院前卒中量表在不降低敏感性的情况下表现相似甚至更好。
结论
对面-臂-言语-时间评分进行简单修改或评估NIHSS症状特征可能有助于对患者LAVO风险进行分层，并识别出值得快速转运至综合卒中中心的个体。需要在院前环境中进行前瞻性验证。
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