Krajíčková Dagmar, Krajina Antonín, Herzig Roman, Lojík Miroslav, Chovanec Vendelín, Raupach Jan, Vítková Eva, Waishaupt Jan, Vyšata Oldřich, Vališ Martin
Departments of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
Diagn Interv Radiol. 2017 Nov-Dec;23(6):465-471. doi: 10.5152/dir.2017.17049.
We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6-8 h/unknown onset time, as only limited data are available for a time window beyond 6 h.
Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time. All patients underwent unenhanced computed tomography (CT) of the brain, CT angiography of the cervical and intracranial arteries and digital subtraction angiography. Perfusion CT was performed in patients beyond a 6-hour time window/with unknown onset time. We collected the following data: baseline characteristics, presence of risk factors, neurologic deficit at the time of treatment, time to therapy, recanalization rate, and 3-month clinical outcome. Successful recanalization was defined as Thrombolysis in Cerebral Infarction score of 2b/3 and good clinical outcome as modified Rankin scale value of 0-2 points.
Successful recanalization was achieved in 82 patients (74.5%): in 61 patients treated within 6 h (73.5%), 7 patients treated within 6-8 h (63.6%), and 13 patients with unknown onset time (81.3%). Good 3-month clinical outcome was achieved in 61 patients (55.5%): in 46 patients treated within 6 h (55.4%), 5 patients treated within 6-8 h (45.5%), and 10 patients with unknown onset time (62.5%). Recanalization success or clinical outcome were not significantly different between patients treated at different time windows.
Our data confirms the safety and effectiveness of mechanical recanalization performed in carefully selected patients with ischemic stroke in the anterior circulation within 8 h of stroke onset or with unknown onset time in everyday practice.
我们旨在评估在症状发作后8小时内及发作时间不明的前循环缺血性脑卒中患者中进行机械再通的安全性和有效性。我们比较了时间间隔<6小时与6 - 8小时/发作时间不明的情况，因为6小时以上时间窗的相关数据有限。
我们的队列包括110例连续的患者（44例男性；平均年龄73.0±11.5岁），这些患者因颅内大血管急性闭塞导致前循环缺血性脑卒中，在8小时时间窗内或发作时间不明时接受了机械再通治疗。所有患者均接受了脑部非增强计算机断层扫描（CT）、颈部和颅内动脉CT血管造影以及数字减影血管造影。发作时间超过6小时/发作时间不明的患者进行了灌注CT检查。我们收集了以下数据：基线特征、危险因素的存在情况、治疗时的神经功能缺损、治疗时间、再通率以及3个月时的临床结局。成功再通定义为脑梗死溶栓评分2b/3，良好的临床结局定义为改良Rankin量表评分为0 - 2分。
82例患者（74.5%）实现了成功再通：61例在6小时内接受治疗的患者中（73.5%），7例在6 - 8小时内接受治疗的患者中（63.6%），13例发作时间不明的患者中（81.3%）。61例患者（55.5%）获得了良好的3个月临床结局：46例在6小时内接受治疗的患者中（55.4%），5例在6 - 8小时内接受治疗的患者中（45.5%），10例发作时间不明的患者中（62.5%）。不同时间窗治疗的患者之间再通成功或临床结局无显著差异。
我们的数据证实了在日常实践中，对精心挑选的前循环缺血性脑卒中患者在卒中发作8小时内或发作时间不明时进行机械再通的安全性和有效性。
