Department of Neurology, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China.
Department of Neurology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China.
Sci Rep. 2022 May 6;12(1):7445. doi: 10.1038/s41598-022-11459-3.
Stroke thrombolysis treatment is generally administered within 4.5 h, but a greater time window may be permitted depending upon the ischemic penumbra on neuroimaging. This observational cohort study investigated the outcomes of thrombolysis given within 12 h after symptom onset of lenticulostriate artery stroke. The population comprised 160 patients. Thrombolysis was administered via tissue plasminogen activator, alteplase (TPA). Thrombolysis was indicated by a mismatch between diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI), that is, an acute ischemic lesion on DWI without a corresponding lesion on T2WI. Demographics and medical history were compared with the modified Rankin scale (mRS) score, to reflect outcome. Patients with a favorable clinical outcome (mRS 0-1) had significantly lower hypertension, baseline NIH Stroke Scale (NIHSS) score, and admission systolic/diastolic blood pressure compared with patients with mRS 2-6. Lower admission systolic blood pressure and NIHSS score were significantly associated with favorable outcome. In patients either with IV-TPA within 4.5 h, or between 4.5 and 12 h, lower admission systolic blood pressure and/or NIHSS score similarly independently predict favorable outcome. However, in all groups, the onset-to-treatment time did not significantly influence the outcomes. We conclude that in our cohort higher admission systolic blood pressure and higher baseline NIHSS and not time were associated with poor outcome in patients with magnetic resonance-guided thrombolysis within 12 h of isolated lenticulostriate artery stroke, therefore loosening the traditionally perceived dependency of outcome on time.
卒中溶栓治疗一般在发病后 4.5 小时内进行，但根据神经影像学的缺血半暗带，可能会允许更大的时间窗。本观察性队列研究调查了在纹状体动脉卒中发病后 12 小时内给予溶栓的结果。该人群包括 160 名患者。溶栓通过组织型纤溶酶原激活物（t-PA）给予。溶栓的指征是弥散加权成像（DWI）与 T2 加权成像（T2WI）之间不匹配，即 DWI 上有急性缺血性病变，而 T2WI 上无相应病变。比较了人口统计学和病史与改良 Rankin 量表（mRS）评分，以反映结果。与 mRS 2-6 相比，临床结局良好（mRS 0-1）的患者高血压、基线 NIH 卒中量表（NIHSS）评分和入院收缩压/舒张压明显较低。入院收缩压和 NIHSS 评分较低与良好的预后显著相关。在 IV-TPA 治疗时间在 4.5 小时内或在 4.5 至 12 小时之间的患者中，入院收缩压和/或 NIHSS 评分较低同样独立地预测良好的预后。然而，在所有组中，发病至治疗时间均未显著影响结局。我们的结论是，在我们的队列中，较高的入院收缩压和较高的基线 NIHSS 而不是时间与磁共振引导溶栓治疗孤立性纹状体动脉卒中后 12 小时内患者的不良结局相关，因此放宽了对时间依赖性结局的传统认识。
