Kim Dae-Hyun, Lee Deok-Soo, Nah Hyun-Wook, Cha Jae-Kwan
Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea.
Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea.
BMC Neurol. 2018 Mar 15;18(1):30. doi: 10.1186/s12883-018-1033-4.
A significant proportion of patients with mild ischemic stroke become disabled despite receiving intravenous thrombolytic therapy. The purpose of this study was to assess the clinical and radiological factors associated with unfavorable outcomes in patients with minor ischemic stroke that received intravenous recombinant tissue plasminogen activator (rt-PA) therapy.
We identified anterior circulation stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 who received intravenous thrombolysis within 4.5 h of stroke onset and had pretreatment magnetic resonance (MR)/MR angiography using our prospective stroke database. We analyzed baseline characteristics, infarction patterns on diffusion-weighted imaging (DWI), and steno-occlusive lesions on MR angiography. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score ≥ 2 at 90 days. Logistic regression was used to determine independent predictors of unfavorable outcomes.
Among 121 patients (85 men; mean age, 63.4 ± 11.3 years) included in this study, 46 (38%) had unfavorable outcomes at 90 days and DWI lesion patterns showing infarction in the deep middle cerebral artery (MCA) territory involving the perforating artery area was observed in 47 (38.8%) patients. On multivariable analysis, unfavorable outcomes at 90 days were associated with diabetes [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.06-10.9; P = 0.039), NIHSS score on admission (OR, 2.11; 95% CI, 1.35-3.30; P = 0.001), and infarction in the deep MCA territory on DWI (OR, 4.19; 95% CI, 1.63-10.8; P = 0.003). Lesions in the deep MCA territory was independently associated with early neurological deterioration (P = 0.032). The patients without deep MCA territory infarction had a higher prevalence of cardiac embolism (P = 0.009).
Higher NIHSS scores, diabetes, and deep MCA territory infarction may be useful for predicting unfavorable outcomes in patients with minor stroke treated with intravenous rt-PA therapy.
相当一部分轻度缺血性中风患者尽管接受了静脉溶栓治疗仍出现残疾。本研究的目的是评估接受静脉重组组织型纤溶酶原激活剂（rt-PA）治疗的轻度缺血性中风患者预后不良的临床和影像学因素。
我们使用前瞻性中风数据库，确定了初始美国国立卫生研究院卒中量表（NIHSS）评分≤5、在中风发作4.5小时内接受静脉溶栓治疗且在治疗前进行了磁共振（MR）/磁共振血管造影的前循环中风患者。我们分析了基线特征、扩散加权成像（DWI）上的梗死模式以及磁共振血管造影上的狭窄闭塞性病变。不良预后定义为90天时改良Rankin量表（mRS）评分≥2。采用逻辑回归确定不良预后的独立预测因素。
本研究纳入的121例患者（85例男性；平均年龄63.4±11.3岁）中，46例（38%）在90天时预后不良，47例（38.8%）患者的DWI病变模式显示大脑中动脉（MCA）深部分支区域梗死累及穿支动脉区域。多变量分析显示，90天时预后不良与糖尿病[比值比（OR），3.41；95%置信区间（CI），1.06-10.9；P=0.039]、入院时NIHSS评分（OR，2.11；95%CI，1.35-3.30；P=0.001）以及DWI上MCA深部分支区域梗死（OR，4.19；95%CI，1.63-10.8；P=0.003）有关。MCA深部分支区域病变与早期神经功能恶化独立相关（P=0.032）。无MCA深部分支区域梗死的患者心脏栓塞患病率较高（P=0.009）。
较高的NIHSS评分、糖尿病和MCA深部分支区域梗死可能有助于预测接受静脉rt-PA治疗的轻度中风患者的不良预后。
