Sung Sang Min, Lee Tae Hong, Cho Han Jin, Cho Gi Yong, Jung Dae Soo, Lee Jae Il, Ko Jun Kyeung, Yip Samuel
Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Diagnostic Radiology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
J Clin Neurosci. 2017 Jul;41:66-70. doi: 10.1016/j.jocn.2017.02.021. Epub 2017 Mar 2.
Patients who have acute stroke symptoms present on awakening are ineligible for standard intravenous thrombolysis due to the unclear onset time of symptoms. Some of these wake-up stroke (WUS) patients may benefit from endovascular recanalization. This study aimed to evaluate clinical predictors of outcomes from endovascular recanalization in WUS patients.
Forty-one WUS patients with internal carotid (ICA) or middle cerebral artery (MCA) occlusion treated with endovascular recanalization were reviewed. Regression analysis was performed to measure clinical predictors of outcomes from endovascular recanalization in WUS patients.
The mean initial NIHSS score was 16.41±4.96 (5-24). The mean symptom recognition-to-door time (SRDT) was 108.85±65.80 (19-230)min. Successful recanalization (TICI 2b-3) was achieved in 29 patients (70.7%). Thirty-four patients improved on NIHSS (amount 7.59±4.84, range; 1-17) at 7days after recanalization. At 90days after recanalization, a mRS of ≤2 was achieved in 19 patients (46.3%) and a mRS of ≤3 was achieved in 24 patients (58.5%). No symptomatic intracerebral hemorrhage occurred. Multivariate regression analysis identified SRDT (P=0.019), successful recanalization (P=0.005), and hypertension (P=0.013) were factors associated with an improvement of the NIHSS score. For a good functional outcome at 90days, SRDT (P=0.036) and initial NIHSS score (P=0.016) were found to be significant predictors.
The results of this study suggest that the SRDT is an independent predictor of both an improvement of NIHSS score and a good functional outcome in endovascular recanalization for WUS patients.
因症状发作时间不明,醒来时出现急性卒中症状的患者不符合标准静脉溶栓条件。部分醒后卒中(WUS)患者可能从血管内再通治疗中获益。本研究旨在评估WUS患者血管内再通治疗结局的临床预测因素。
回顾41例接受血管内再通治疗的颈内动脉(ICA)或大脑中动脉(MCA)闭塞的WUS患者。进行回归分析以测定WUS患者血管内再通治疗结局的临床预测因素。
初始美国国立卫生院卒中量表(NIHSS)评分均值为16.41±4.96(5 - 24)。症状识别至入院时间(SRDT)均值为108.85±65.80(19 - 230)分钟。29例患者(70.7%)实现成功再通(脑梗死溶栓分级(TICI)2b - 3级)。34例患者在再通后7天NIHSS评分改善(改善值7.59±4.84,范围:1 - 17)。再通后90天,19例患者(46.3%)改良Rankin量表(mRS)评分≤2,24例患者(58.5%)mRS评分≤3。未发生有症状性脑出血。多因素回归分析确定SRDT(P = 0.019)、成功再通(P = 0.005)和高血压(P = 0.013)是与NIHSS评分改善相关的因素。对于90天时良好的功能结局,发现SRDT(P = 0.036)和初始NIHSS评分(P = 0.016)是显著预测因素。
本研究结果表明,SRDT是WUS患者血管内再通治疗中NIHSS评分改善及良好功能结局的独立预测因素。