Derbisz Justyna M, Wnuk Marcin, Popiela Tadeusz, Jagiełła Jeremiasz, Pułyk Roman, Słowik Joanna, Dziedzic Tomasz, Turaj Wojciech, Słowik Agnieszka
Department of Neurology, University Hospital, Krakow, Poland.
Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Pol J Radiol. 2021 Jun 11;86:e344-e352. doi: 10.5114/pjr.2021.107065. eCollection 2021.
According to guidelines, to shorten the treatment window, acute ischaemic stroke (AIS) treatment by intravenous thrombolysis (IVT) can be done based on the results of head computed tomography (CT) without contrast. The impact of large vessel occlusion (LVO) on computed tomography angiography (CTA) in stroke prognosis in patients treated IVT or IVT and mechanical thrombectomy (MT), where indicated, has not yet been studied systematically. We investigated the influence of LVO in consecutive AIS patients on haemorrhagic transformation (HT) on CT 24 h after treatment, mRS < 2 on discharge (unfavourable outcome), and in-hospital mortality.
We analysed several parameters within 24 h after AIS: demographics, risk factors, mRS score pre-stroke, NIHSS upon admission and 24 h later, several clinical and biochemical parameters, and chronic treatment.
We registered 1209 patients, of whom 362 (29.9%) received IVT and 108 had MT, where indicated. Admission CTA showed LVO in 197 patients (54.4%). Multivariate regression analysis showed that the presence of LVO and lower delta NIHSS (NIHSS on admission minus NIHSS 24 hours later) were independent parameters affecting HT risk. Multivariate analysis showed that the presence LVO and also older age, female sex, lower delta NIHSS, HT, stroke-associated infection, CRP levels ≥ 10 mg/L, and higher WBC count affected unfavourable outcome on discharge. LVO did not affect in-hospital mortality.
LVO in AIS patients treated by IVT or IVT and MT affects the risk of HT and unfavourable short-term outcome but not in-hospital mortality.
根据指南，为缩短治疗窗，急性缺血性卒中（AIS）可通过静脉溶栓（IVT）治疗，且可基于非增强头颅计算机断层扫描（CT）结果进行。大血管闭塞（LVO）对接受IVT或IVT联合机械取栓（MT，如有指征）治疗的卒中患者的CT血管造影（CTA）预后的影响尚未得到系统研究。我们调查了连续性AIS患者中LVO对治疗后24小时CT上出血转化（HT）、出院时改良Rankin量表（mRS）评分<2（不良结局）及住院死亡率的影响。
我们分析了AIS后24小时内的多个参数：人口统计学资料、危险因素、卒中前mRS评分、入院时及24小时后的美国国立卫生研究院卒中量表（NIHSS）评分、多项临床和生化参数以及慢性治疗情况。
我们登记了1209例患者，其中362例（29.9%）接受了IVT治疗，108例在有指征时接受了MT治疗。入院CTA显示197例患者（54.4%）存在LVO。多因素回归分析显示，LVO的存在及较低的NIHSS差值（入院时NIHSS评分减去24小时后的NIHSS评分）是影响HT风险的独立参数。多因素分析显示，LVO的存在以及年龄较大、女性、较低的NIHSS差值、HT、卒中相关感染、C反应蛋白（CRP）水平≥10 mg/L及较高的白细胞计数影响出院时的不良结局。LVO不影响住院死亡率。
接受IVT或IVT联合MT治疗的AIS患者中，LVO影响HT风险及短期不良结局，但不影响住院死亡率。
