Jiang Nan N, Fong Crystal, Sahlas Demetrios J, Monteiro Sandra, Larrazabal Ramiro
Department of Diagnostic Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
Divison of Neurology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):1093-1098. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.037. Epub 2019 Jan 14.
Recent trials have demonstrated superior outcomes with combination IV-tPA and endovascular therapy (EVT) within 6 hours of symptom onset in patients with proximal vessel occlusion (ICA, M1, or proximal M1/M2) compared to IV-tPA alone. The current standard of diagnosis for consideration of EVT is CT angiogram (CTA). Unfortunately, not all hospitals are equipped with CTA, and the decision to transfer to tertiary centers is often based on nonenhanced CT. Ipsilateral conjugate gaze deviation (CGD) is associated with worse outcomes and larger infarcts in acute ischemic stroke. We predicted that the more proximal the occlusion, the higher the degree of CGD.
Over a period of 12 months, 182 consecutive patients with acute ischemic stroke treated at our institution were prospectively analyzed. Stroke locations were categorized based on CTA. Average degree of CGD was measured. Patient demographics, ASPECTS, collateral score, National Institutes of Health Stroke Scale, modified Rankin Scale, TICI score, length-of-stay, and mortality were collected. The median follow-up was 30 days.
Out of ninety one of 182 patients with (+) CGD, 82 (90%) patients had ICA or middle cerebral artery (MCA) territory infarcts. The median was 25.0° in those with proximal occlusion and 13.7° in those with distal MCA occlusion (P < .001). A higher degree of CGD is positively correlated with proximity of vessel occlusion (correlation coefficient 0.2; P < .05). A cut-off greater than 20.25° (area under the curve = .76) showed a sensitivity of 64.0% and specificity 84.2%.
Measuring degree of CGD may help in early identification of proximal vessel occlusions and expedite transfer for clot retrieval.
近期试验表明，对于近端血管闭塞（颈内动脉、大脑中动脉M1段或近端M1/M2段）的患者，在症状发作6小时内联合静脉注射组织型纤溶酶原激活剂（IV-tPA）和血管内治疗（EVT）的效果优于单纯静脉注射IV-tPA。目前考虑进行EVT的诊断标准是CT血管造影（CTA）。不幸的是，并非所有医院都配备了CTA，转至三级中心的决定通常基于非增强CT。同侧共轭凝视偏斜（CGD）与急性缺血性卒中的不良预后和更大梗死灶相关。我们预测，闭塞部位越靠近近端，CGD程度越高。
在12个月的时间里，对我院连续治疗的182例急性缺血性卒中患者进行了前瞻性分析。根据CTA对卒中部位进行分类。测量CGD的平均程度。收集患者的人口统计学数据、脑缺血半暗带评分（ASPECTS）、侧支循环评分、美国国立卫生研究院卒中量表、改良Rankin量表、脑梗死溶栓分级（TICI）评分、住院时间和死亡率。中位随访时间为30天。
在182例CGD阳性患者中的91例中，82例（90%）患者发生颈内动脉或大脑中动脉（MCA）区域梗死。近端闭塞患者的CGD中位数为25.0°，远端MCA闭塞患者的CGD中位数为13.7°（P < 0.001）。CGD程度越高与血管闭塞的近端程度呈正相关（相关系数0.2；P < 0.05）。截断值大于20.25°（曲线下面积 = 0.76）时，敏感性为64.0%，特异性为84.2%。
测量CGD程度可能有助于早期识别近端血管闭塞，并加快转运以进行血栓清除。
