Armon Carmel, Wainstein Jochay, Gour Aviv, Levite Ronen, Bartal Avigail, Kriboushay Angela, Kenan Gilad, Khiri Fikri, Shevtzov Evelina, Aroesty Rina, Bhonkar Sarah, Tal Sigal, Ilgiyaev Eduard, Blatt Alex, Haitov Zoya, Bar-Hayim Samuel, Kimiagar Itzhak
Departments of Neurology, Sackler Faculty of Medicine and Shamir (Assaf Harofeh) Medical Center, Tel Aviv University, Tel Aviv, Israel.
Departments of Radiology, Sackler Faculty of Medicine and Shamir (Assaf Harofeh) Medical Center, Tel Aviv University, Tel Aviv, Israel.
eNeurologicalSci. 2019 Feb 5;14:91-97. doi: 10.1016/j.ensci.2019.02.002. eCollection 2019 Mar.
Observational studies of thrombolysis outcomes in wake-up acute ischemic stroke patients selected based on non-contrast brain CT criteria suggested that treated patients did as well as or better than those not treated, after adjustment for baseline characteristics. We began offering thrombolytic treatment (IVTPA) to patients presenting with wake-up strokes and normal non-contrast brain CTs, who could be treated within 4.5 h of being found.
DESIGN/METHODS: A retrospective chart review was performed in patients presenting with AIS between November 2014 and December 2017 who received IVTPA. A planned subgroup analysis compared patients with wake-up strokes and normal non-contrast brain CTs to patients with witnessed stroke treated within 4.5 h of being found, or of witnessed onset, respectively.
Three hundred and six patients were treated, 279 with witnessed-onset and 27 with wake-up strokes. The latter were not candidates for endovascular intervention. Efficacy and safety were similar in both groups. Discharges home, respectively, were 143(53%) and 13(48%); facility discharges were 112(40.1%) and 11(40.7%) and in-hospital mortality was 19 (6.8%) and 3 (11%). Treatment-related symptomatic bleeds were: 5(1.8%) and 1 (3.7%), respectively.
The findings affirm, in a new clinical series reflecting routine practice, that it is safe to treat with IVTPA patients with wake-up strokes and a normal brain CT scan, who are not candidates for endovascular intervention. We hypothesize, that when the non-contrast brain CT scan is normal, it may be safe to extend beyond 4.5 h the IVTPA treatment eligibility window in similar patients with witnessed-onset stroke.
基于非增强脑部CT标准选择的醒后急性缺血性卒中患者溶栓结局的观察性研究表明，在对基线特征进行调整后，接受治疗的患者与未接受治疗的患者表现相当或更好。我们开始为出现醒后卒中且非增强脑部CT正常、在被发现后4.5小时内可接受治疗的患者提供溶栓治疗（静脉注射组织型纤溶酶原激活剂[IVTPA]）。
设计/方法：对2014年11月至2017年12月期间接受IVTPA治疗的急性缺血性卒中患者进行回顾性病历审查。一项计划中的亚组分析将醒后卒中且非增强脑部CT正常的患者分别与在被发现后4.5小时内接受治疗的有目击者卒中患者或有目击发病的患者进行比较。
共治疗了306例患者，其中279例为有目击发病，27例为醒后卒中。后者不适合进行血管内介入治疗。两组的疗效和安全性相似。分别有143例（53%）和13例（48%）出院回家；机构出院分别为112例（40.1%）和11例（40.7%），住院死亡率分别为19例（6.8%）和3例（11%）。治疗相关的症状性出血分别为5例（1.8%）和1例（3.7%）。
在一个反映常规实践的新临床系列中，研究结果证实，对于不适合进行血管内介入治疗、出现醒后卒中且脑部CT扫描正常的患者，使用IVTPA治疗是安全的。我们推测，当非增强脑部CT扫描正常时，对于类似的有目击发病的卒中患者，将IVTPA治疗的适用窗口延长至4.5小时以上可能是安全的。
