The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
Department of Medicine, Stroke Program, University of Alberta, Edmonton, Canada.
PLoS One. 2020 Apr 24;15(4):e0231448. doi: 10.1371/journal.pone.0231448. eCollection 2020.
Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefit from thrombolysis.
We interrogated Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Evaluation was based on localization (lacunar or cortical), multi-model imaging abnormalities and whether they received rt-PA. The 90-day mRS was used to determine outcome.
During study period 6381 patients were admitted with acute stroke. Mild stroke within 4 hours was diagnosed in 506 [no thrombolysis: 381(lacunar: 213; cortical: 168), thrombolysis: 125 (lacunar: 45; cortical: 80)]. The rt-PA treated patients had significantly higher NIHSS (2.94±3.9 versus 1.28±2.46, p<0.0001), increased rates of complications (16.0% versus 3.9%, p<0.0001) and longer hospital stay (6.05±8.1 versus 3.78±3.6 days; p<0.001). In patients with cortical stroke, intracranial arterial occlusions (11.6% vs 3.9%, p<0.0001) and CTP mismatch (22.2% vs 4.4%, p<0.0001) were more frequent in rt-PA treated patients. Discharge mRS (33.6% versus 13.9%, p<0.001) and 90-days mRS (23.2% versus 11.8%, p = 0.002) was significantly worse in patients with cortical stroke (rt-PA-treated and untreated patients).
The outcome in patients with mild stroke depends on lesion location (lacunar versus cortical) and severity of symptoms. Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of hospital complication, explaining the poor outcome in such subjects.
急性脑卒中且症状轻微或迅速改善的患者常出现进展。此类患者的再灌注治疗作用尚不明确。我们推测皮质定位的患者最有可能出现进展，此类患者可能从溶栓治疗中获益。
我们分析了哈马德脑卒中数据库，评估了发病 4 小时内、NIHSS 评分≤6 的急性缺血性脑卒中患者 90 天的预后。评估基于定位（腔隙性或皮质性）、多模式影像学异常以及是否接受 rt-PA 治疗。采用 90 天 mRS 评估预后。
研究期间共纳入 6381 例急性脑卒中患者。诊断为 4 小时内轻度脑卒中的患者有 506 例[未溶栓：381 例（腔隙性 213 例；皮质性 168 例），溶栓：125 例（腔隙性 45 例；皮质性 80 例）]。rt-PA 治疗的患者 NIHSS 更高（2.94±3.9 比 1.28±2.46，p＜0.0001）、并发症发生率更高（16.0%比 3.9%，p＜0.0001）、住院时间更长（6.05±8.1 比 3.78±3.6 天；p＜0.001）。皮质性脑卒中患者 rt-PA 治疗的颅内动脉闭塞（11.6%比 3.9%，p＜0.0001）和 CTP 不匹配（22.2%比 4.4%，p＜0.0001）更为常见。皮质性脑卒中患者出院时 mRS（33.6%比 13.9%，p＜0.001）和 90 天时 mRS（23.2%比 11.8%，p=0.002）更差（rt-PA 治疗和未治疗的患者）。
轻度脑卒中患者的预后取决于病变部位（腔隙性与皮质性）和症状严重程度。接受 rt-PA 治疗的患者神经功能缺损更大、影像学异常更严重、住院并发症发生率更高，这也解释了此类患者预后较差的原因。
