Merlino Giovanni, Corazza Elisa, Lorenzut Simone, Gigli Gian Luigi, Cargnelutti Daniela, Valente Mariarosaria
Stroke Unit, Department of Neurosciences, Udine University Hospital, 33100 Udine, Italy.
Department of Neurosciences, Clinical Neurology, Udine University Hospital, 33100 Udine, Italy.
J Clin Med. 2019 Mar 22;8(3):400. doi: 10.3390/jcm8030400.
Little is known about intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with pre-existing disability. Disabled patients are often excluded from IVT treatment. Previous studies investigated the role of pre-existing disability on outcomes in AIS patients after IVT. However, no studies have been conducted to date to determine whether IVT may improve clinical outcomes in AIS patients with pre-existing disability. The aim of our study was to evaluate efficacy and safety of IVT in patients with pre-existing moderate and moderately severe disability (pre-stroke modified Rankin Scale score = 3 or 4) affected by AIS. This study was based on a retrospective analysis of a prospectively collected database of consecutive patients admitted to the Udine University Hospital with AIS from January 2015 to May 2018. The efficacy endpoints were the rate of favorable outcome and rate of major neurological improvement. The safety endpoints were the rate of mortality at three months, presence of intracranial hemorrhage (ICH), and presence of symptomatic intracranial hemorrhage (sICH). The study population included 110 AIS patients with pre-existing moderate and moderately severe disability, 36 of which received (IVT+) and 74 did not receive IVT (IVT-). AIS disabled patients treated with IVT had higher rates of favorable outcome (66.7% vs. 36.5%, = 0.003) and major neurological improvement (39.4% vs. 17.4%, = 0.01) compared to non-treated ones. Two in three disabled patients returned to their pre-stroke functional status when treated with IVT. Prevalence of three-month mortality, ICH, and sICH did not differ in the two groups. Disabled patients affected by AIS significantly improved after IVT. Moderate and moderately severe disability alone should not be considered, per se, as a contraindication to IVT treatment.
对于已有残疾的急性缺血性卒中（AIS）患者进行静脉溶栓治疗（IVT）的了解甚少。残疾患者通常被排除在IVT治疗之外。既往研究探讨了已有残疾对AIS患者IVT治疗后结局的影响。然而，迄今为止，尚未有研究确定IVT是否可改善已有残疾的AIS患者的临床结局。我们研究的目的是评估IVT对已有中度和中度严重残疾（卒中前改良Rankin量表评分为3或4分）的AIS患者的疗效和安全性。本研究基于对2015年1月至2018年5月在乌迪内大学医院连续收治的AIS患者的前瞻性收集数据库进行回顾性分析。疗效终点为良好结局率和主要神经功能改善率。安全性终点为3个月时的死亡率、颅内出血（ICH）的发生情况以及症状性颅内出血（sICH）的发生情况。研究人群包括110例已有中度和中度严重残疾的AIS患者，其中36例接受了IVT（IVT+组），74例未接受IVT（IVT-组）。与未接受治疗的患者相比，接受IVT治疗的AIS残疾患者具有更高的良好结局率（66.7%对36.5%，P = 0.003）和主要神经功能改善率（39.4%对17.4%，P = 0.01）。三分之二的残疾患者接受IVT治疗后恢复到了卒中前的功能状态。两组的三个月死亡率、ICH和sICH的发生率无差异。AIS残疾患者接受IVT治疗后有显著改善。仅中度和中度严重残疾本身不应被视为IVT治疗的禁忌证。
