Division of Interventional Neuroradiology, Department of Radiological Sciences (H.S., K.K., V.S., S.T., G.P.C., M.N., R.J., G.D.), University of California, Los Angeles (UCLA).
Department of Neurosurgery (G.P.C.), University of California, Los Angeles (UCLA).
Stroke. 2020 Nov;51(11):3241-3249. doi: 10.1161/STROKEAHA.120.030898. Epub 2020 Oct 21.
More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice has not been well-delineated.
Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0-5) from October 1, 2016, to December 31, 2017. Patient- and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death); in-hospital mortality; and radiological intracranial hemorrhage.
Among 179 710 acute ischemic stroke admissions with recorded NIHSS during the 15-month study period, 103 765 (57.7%) had mild strokes (47.3% women; median age, 69 [interquartile range, 59-79] years; median NIHSS score of 2 [interquartile range, 1-4]). Considering reperfusion therapies among strokes with documented NIHSS, mild deficit hospitalizations accounted for 40.0% of IVT and 10.7% of mechanical thrombectomy procedures. Characteristics associated with IVT and with mechanical thrombectomy utilization were younger age, absence of diabetes, higher NIHSS score, larger/teaching hospital status, and Western US region. Excellent discharge outcome occurred in 48.2% of all mild strokes, and in multivariable analysis, was associated with younger age, male sex, White race, lower NIHSS score, absence of diabetes, heart failure, and kidney disease, and IVT use. IVT was associated with increased likelihood of excellent outcome (odds ratio, 1.90 [95% CI, 1.71-2.13], <0.001) despite an increased risk of intracranial hemorrhage (odds ratio, 1.41 [95% CI, 1.09-1.83], <0.001).
In national US practice, more than one-half of acute ischemic stroke hospitalizations had mild deficits, accounting for 4 of every 10 IVT and 1 of every 10 mechanical thrombectomy treatments, and IVT use was associated with increased discharge to home despite increased intracranial hemorrhage.
超过一半的急性缺血性脑卒中患者存在轻度神经功能缺损；然而，常规实践中再灌注治疗的频率和结果尚未明确。
对 2016 年 10 月 1 日至 2017 年 12 月 31 日期间因急性缺血性脑卒中且轻度神经功能缺损（美国国立卫生研究院卒中量表 [NIHSS]评分 0-5 分）住院的美国国家住院患者样本进行分析。分析了与再灌注治疗使用和结局相关的患者和医院特征。主要结局包括出院时的良好转归（无需辅助即可出院回家）；不良转归（出院至医疗机构或死亡）；住院死亡率；以及影像学颅内出血。
在 15 个月的研究期间，179710 例记录有 NIHSS 的急性缺血性脑卒中住院患者中，103765 例（47.3%为女性；中位年龄 69 [四分位间距，59-79] 岁；中位 NIHSS 评分为 2 [四分位间距，1-4]）存在轻度脑卒中。在有 NIHSS 记录的脑卒中患者中，考虑再灌注治疗，轻度缺陷住院患者占 IVT 的 40.0%和机械取栓术的 10.7%。与 IVT 和机械取栓术应用相关的特征是年龄较小、无糖尿病、NIHSS 评分较高、较大/教学医院地位以及美国西部地区。所有轻度脑卒中患者中，出院结局良好的比例为 48.2%，多变量分析显示，年龄较小、男性、白人、NIHSS 评分较低、无糖尿病、心力衰竭和肾脏疾病以及 IVT 应用与出院结局良好相关。尽管颅内出血风险增加（比值比 1.41 [95%CI，1.09-1.83]，<0.001），但 IVT 与更好的结局（比值比 1.90 [95%CI，1.71-2.13]，<0.001）相关。
在美国的常规实践中，超过一半的急性缺血性脑卒中住院患者存在轻度神经功能缺损，占每 10 例 IVT 和每 10 例机械取栓术治疗的 4 例，IVT 的应用与出院回家的比例增加相关，尽管颅内出血的风险增加。
