Paek Young Min, Lee Ji Sung, Park Hong-Kyun, Cho Yong-Jin, Bae Hee-Joon, Kim Beom Joon, Park Jong-Moo, Lee Soo Joo, Cha Jae-Kwan, Park Tai Hwan, Lee Kyung Bok, Lee Jun, Lee Byung-Chul, Kim Joon-Tae, Kim Dong-Eog, Shin Dong-Ick, Kim Wook-Joo, Sohn Sung-Il, Choi Jay Chol, Hong Keun-Sik
Department of Neurology, Ilsan Paik Hospital Inje University, Goyang, Republic of Korea.
Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea.
J Clin Neurosci. 2019 Jun;64:134-140. doi: 10.1016/j.jocn.2019.03.036. Epub 2019 Apr 2.
Intravenous tissue-plasminogen activator (IV-TPA) treatment in acute ischemic stroke (AIS) patients due to small vessel occlusion (SVO) has been debated because of its small expected benefit and symptomatic intracranial hemorrhage (SICH) risk. Furthermore, data on subgroups of SVO patients are limited. From a prospective multicenter stroke registry database, AIS patients due to SVO within 24 h from onset were selected. Efficacy outcomes were 3-month modified Rankin Scale (mRS) score 0-1 proportion and mRS score distribution. Additionally, subgroup analyses were conducted by age, sex, initial National Institute Health Stroke Scale (NIHSS) score, and presenting limb paresis. This study included 2482 patients: 193 in the IV-TPA group and 2289 in the control group. After adjusting covariates, IV-TPA treatment was associated with an increased mRS 0-1 outcome (adjusted OR [95% CI], 1.56 [1.06-2.29]; P = 0.0249), but was not significantly associated with a favorable mRS shift (1.33 [0.98-1.81]; P = 0.0709). SICH and 3-month death occurred in three (1.6%) and none in the IV-TPA group versus one (0.04%) and 16 (0.7%) in the control group. In subgroup analyses, the IV-TPA effect appeared significantly greater in patients aged ≥80 versus <80 for mRS score distribution (P = 0.012). This study showed that, in SVO patients, IV-TPA within 4.5 h may improve functional outcome with a low SICH risk. The benefit appeared more substantial in patients aged ≥80.
由于预期益处较小且存在症状性颅内出血（SICH）风险，急性缺血性卒中（AIS）伴小血管闭塞（SVO）患者的静脉组织型纤溶酶原激活剂（IV-TPA）治疗一直存在争议。此外，关于SVO患者亚组的数据有限。从一个前瞻性多中心卒中登记数据库中，选取发病24小时内由SVO导致的AIS患者。疗效指标为3个月改良Rankin量表（mRS）评分为0-1的比例及mRS评分分布。此外，还按年龄、性别、初始美国国立卫生研究院卒中量表（NIHSS）评分和出现肢体轻瘫情况进行亚组分析。本研究纳入2482例患者：IV-TPA组193例，对照组2289例。调整协变量后，IV-TPA治疗与mRS评分为0-1的结局增加相关（调整后OR[95%CI]，1.56[1.06-2.29]；P = 0.0249），但与mRS评分有利变化无显著关联（1.33[0.98-1.81]；P = 0.0709）。IV-TPA组有3例（1.6%）发生SICH且3个月内无死亡病例，而对照组有1例（0.04%）发生SICH，16例（0.7%）死亡。在亚组分析中，对于mRS评分分布，年龄≥80岁的患者IV-TPA效果显著大于年龄<80岁的患者（P = 0.012）。本研究表明，在SVO患者中，4.5小时内使用IV-TPA可能改善功能结局且SICH风险较低。这种益处似乎在年龄≥80岁的患者中更为显著。
