Pikija Slaven, Magdic Jozef, Sztriha Laszlo K, Killer-Oberpfalzer Monika, Bubel Nele, Lukic Anita, Sellner Johann
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
Department of Neurology, University Medical Center Maribor, Maribor 2000, Slovenia.
J Clin Med. 2019 Feb 10;8(2):228. doi: 10.3390/jcm8020228.
Ischemic stroke related to tandem internal carotid and middle cerebral artery (TIM) occlusion is a challenging condition where endovascular treatment (EVT) is an emerging revascularization option. The identification of factors influencing clinical outcomes can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to evaluate prognostic factors in the context of EVT for TIM occlusion. We performed a retrospective study of consecutive patients with TIM occlusion admitted within 6 h from symptom onset to two tertiary stroke centers. We recorded the etiology of stroke, clinical deficits at stroke onset and discharge, details of EVT, final infarct volume (FIV), in-hospital mortality, and outcome at three months. Among 73 patients with TIM occlusion, 53 were treated with EVT. The median age was 75.9 years (interquartile range (IQR) 64.6⁻82.6), with the most common etiology of cardioembolism (51.9%). Intravenous thrombolysis with tissue-plasminogen activator (t-PA) was performed in the majority (69.8%) of cases. EVT achieved successful recanalization with a thrombolysis in cerebral infarction (TICI) grade of 2b or 3 in 67.9%. A good outcome (modified Rankin score of 0⁻2 at three months) was observed in 37.7%. After adjustment for age, the National Institutes of Health Stroke Scale (NIHSS) at admission, and success of recanalization, smaller final infarct volume (odds ratio (OR) 0.021 for FIV above 25th percentile (95% CI 0.001⁻0.332, = 0.005)) and administration of intravenous t-PA (OR 12.04 (95% CI 1.004⁻144.392, = 0.049)) were associated with a good outcome at three months. Our study demonstrates that bridging with t-PA is associated with improved outcomes in the setting of tandem ICA and MCA occlusions treated with EVT and should therefore not be withheld in eligible patients.
与颈内动脉和大脑中动脉串联闭塞（TIM）相关的缺血性卒中是一种具有挑战性的病症，血管内治疗（EVT）是一种新兴的血管再通选择。识别影响临床结局的因素有助于为此类患者制定合适的治疗方案。本研究旨在评估TIM闭塞患者接受EVT治疗时的预后因素。我们对两个三级卒中中心在症状发作后6小时内收治的连续TIM闭塞患者进行了回顾性研究。我们记录了卒中病因、卒中发作时和出院时的临床缺陷、EVT细节、最终梗死体积（FIV）、住院死亡率以及三个月时的结局。在73例TIM闭塞患者中，53例接受了EVT治疗。中位年龄为75.9岁（四分位间距（IQR）64.6⁻82.6），最常见的病因是心源性栓塞（51.9%）。大多数病例（69.8%）使用组织型纤溶酶原激活剂（t-PA）进行了静脉溶栓。EVT实现成功再通，脑梗死溶栓（TICI）分级为2b或3级的比例为67.9%。三个月时观察到良好结局（改良Rankin评分0⁻2）的比例为37.7%。在调整年龄、入院时美国国立卫生研究院卒中量表（NIHSS）评分和再通成功情况后，较小的最终梗死体积（FIV高于第25百分位数时的比值比（OR）为0.021（95%置信区间0.001⁻0.332，P = 0.005））和静脉注射t-PA（OR 12.04（95%置信区间1.004⁻144.392，P = 0.049））与三个月时的良好结局相关。我们的研究表明，在接受EVT治疗的颈内动脉和大脑中动脉串联闭塞患者中，桥接t-PA与改善结局相关，因此在符合条件的患者中不应拒绝使用。
