Tian Huiqiao, Parsons Mark W, Levi Christopher R, Cheng Xin, Aviv Richard I, Spratt Neil J, Kleinig Timothy J, O'Brien Billy, Butcher Kenneth S, Lin Longting, Zhang Jingfen, Dong Qiang, Chen Chushuang, Bivard Andrew
Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
Front Neurol. 2018 Jun 6;9:405. doi: 10.3389/fneur.2018.00405. eCollection 2018.
The benefit of thrombolysis in ischemic stroke patients without a visible vessel occlusion still requires investigation. This study tested the hypothesis that non-lacunar stroke patients with no visible vessel occlusion on baseline imaging would have a favorable outcome regardless of treatment with alteplase. We utilized a prospectively collected registry of ischemic stroke patients [the International Stroke Perfusion Imaging Registry (INSPIRE)] who had baseline computed tomographic perfusion and computed tomographic angiography. The rates of patients achieving modified Rankin Scale (mRS) 0-1 were compared between alteplase treated and untreated patients using logistic regression to generate odds ratios. Of 1569 patients in the INSPIRE registry, 1,277 were eligible for inclusion. Of these, 306 (24%) had no identifiable occlusion and were eligible for alteplase, with 141 (46%) of these patients receiving thrombolysis. The treated and untreated groups had significantly different median baseline National Institutes of Health Stroke Scale (NIHSS) [alteplase 8, interquartile range (IQR) 5-10, untreated 6, IQR 4-8, < 0.001] and median volume of baseline perfusion lesion [alteplase 5.6 mL, IQR 1.3-17.7 mL, untreated 2.6 mL, IQR 0-6.7 mL, < 0.001]. After propensity analysis, alteplase treated patients without a vessel occlusion were less likely to have an excellent outcome (mRS 0-1; 56%) than untreated (78.8%, OR, 0.42, 95% confidence interval, 0.24-0.75, = 0.003). In this non-randomized comparison, alteplase treatment in patients without an identifiable vessel occlusion did not result in higher rates of favorable outcome compared to untreated. However, treated patients displayed less favorable baseline prognostic factors than the untreated group. Further studies may be required to confirm this data.
对于无可见血管闭塞的缺血性卒中患者，溶栓治疗的益处仍有待研究。本研究检验了这样一个假设：在基线影像学检查中无可见血管闭塞的非腔隙性卒中患者，无论是否接受阿替普酶治疗，都将获得良好预后。我们利用了一个前瞻性收集的缺血性卒中患者登记库[国际卒中灌注成像登记库（INSPIRE）]，这些患者均进行了基线计算机断层扫描灌注和计算机断层血管造影检查。使用逻辑回归生成优势比，比较接受阿替普酶治疗和未接受治疗的患者达到改良Rankin量表（mRS）0 - 1级的比例。在INSPIRE登记库的1569例患者中，1277例符合纳入条件。其中，306例（24%）无明确闭塞且符合阿替普酶治疗条件，这些患者中有141例（46%）接受了溶栓治疗。治疗组和未治疗组的基线美国国立卫生研究院卒中量表（NIHSS）中位数[阿替普酶组为8，四分位间距（IQR）为5 - 10；未治疗组为6，IQR为4 - 8，P < 0.001]以及基线灌注病变的中位数体积[阿替普酶组为5.6 mL，IQR为1.3 - 17.7 mL；未治疗组为2.6 mL，IQR为0 - 6.7 mL，P < 0.001]存在显著差异。经过倾向分析，无血管闭塞且接受阿替普酶治疗的患者获得极佳预后（mRS 0 - 1）的可能性（56%）低于未治疗患者（78.8%，优势比，0.42，95%置信区间，0.24 - 0.75，P = 0.003）。在这项非随机比较中，与未治疗患者相比，对无明确血管闭塞的患者进行阿替普酶治疗并未导致更高的良好预后率。然而，治疗组患者的基线预后因素不如未治疗组有利。可能需要进一步研究来证实这些数据。
