Fan Yu, Liao Xiaoling, Pan Yuesong, Dong Kehui, Wang Yilong, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):220-226. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.041. Epub 2018 Oct 23.
The intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) therapy is safe and efficient during the treatment of acute ischemic stroke. Nonetheless, the different outcomes among various stroke subgroups have limited data with regard to the safety and efficacy of cryptogenic stroke (CS). The present study compared the safety and efficacy when IVT with rt-PA was used for the treatment of CS and the other stroke subtypes.
This study classified the IVT with rt-PA patients within 4.5 hours after stroke onset, based on the trial of ORG 10172 in acute stroke treatment criteria in terms of diagnostic evaluation. The data were obtained from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database, a large multicenter prospective registry. A multivariable logistic regression model was employed to compare the differences between the subtypes in symptomatic intracerebral hemorrhage (sICH) within 7 days and studied the mortality and the outcome during 90 days.
In total, 1118 patients were recruited; of these, 131 (11.7%) suffered from CS and 987 (88.3%) with the other etiology. In the CS group, patients were younger than those in the other etiology groups (P < .001). Moreover, it had a lower prevalence of previous stroke (P = .0117), receiving antiplatelet drug in 24 hours prior to thrombolysis (P = .0017), and functional independence (mRS > 1 before stroke, P = .003). The CS group had lower blood pressure (systolic blood pressure P = .0001; diastolic blood pressure; P = .0212) before thrombolysis, atrial fibrillation (P < .001), and diabetes mellitus (P = .0005). Transient ischemic attack, hypertension, hyperlipidemia, blood glucose, receiving anticoagulants in 24 hours prior to thrombolysis, and standard dosage of rt-PA were equally distributed in both groups. After the adjustment of confounders between the CS and the other subgroups, no obvious differences were observed in sICH rate and mortality (P > .05) The CS patients exhibited excellent recovery (mRS, 0-1; 63.78%) and functional independence (mRS, 0-2; 74.8%) than the large artery atherosclerosis patients.
IVT with rt-PA is a safe and effective method for the treatment of CS patients.
重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性缺血性卒中安全有效。然而，关于隐源性卒中（CS）的安全性和有效性，不同卒中亚组间的不同结局数据有限。本研究比较了rt-PA静脉溶栓治疗CS和其他卒中亚型的安全性和有效性。
本研究根据急性卒中治疗标准中ORG 10172试验的诊断评估，对卒中发作后4.5小时内接受rt-PA静脉溶栓的患者进行分类。数据来自中国急性缺血性卒中溶栓实施与监测数据库，这是一个大型多中心前瞻性登记库。采用多变量逻辑回归模型比较7天内症状性脑出血（sICH）亚型之间的差异，并研究90天内的死亡率和结局。
共纳入1118例患者；其中，131例（11.7%）为CS患者，987例（88.3%）为其他病因患者。CS组患者比其他病因组患者更年轻（P <.001）。此外，其既往卒中患病率较低（P =.0117），溶栓前24小时接受抗血小板药物治疗的比例较低（P =.0017），且功能独立性较差（卒中前mRS>1，P =.003）。CS组溶栓前血压较低（收缩压P =.0001；舒张压P =.0212），房颤（P <.001）和糖尿病患病率较低（P =.0005）。两组间短暂性脑缺血发作、高血压、高脂血症、血糖、溶栓前24小时接受抗凝治疗情况以及rt-PA标准剂量分布均衡。在对CS组和其他亚组之间的混杂因素进行调整后，sICH发生率和死亡率无明显差异（P>.05）。与大动脉粥样硬化患者相比，CS患者恢复良好（mRS，0-1；63.78%）且功能独立（mRS，0-2；74.8%）。
rt-PA静脉溶栓是治疗CS患者的一种安全有效的方法。
