Wang Xueqi, Zhang Hao, Wang Qi, Li Gang, Shen Hao, Xiao Yaping, Xu Luran, Long Yuming, Chen Chen, Huang Zhengyu, Zhang Yue
Shanghai East Hospital, Tongji University, Shanghai, China.
Front Neurol. 2023 Feb 23;14:1096605. doi: 10.3389/fneur.2023.1096605. eCollection 2023.
This study aimed to investigate the effects of recombinant tissue plasminogen activator intravenous thrombolysis (IVT) on the core growth rate of acute ischemic stroke.
Stroke patients with large vessel occlusion and non-recanalization from IVT treatment were retrospectively included in this study and divided into two groups: IVT and non-IVT. The core growth rate was estimated by the acute core volume on perfusion CT divided by the last known well time from stroke to CT perfusion. The primary endpoint was the core growth rate, the tissue outcome was 24 h-ASPECTS, and the clinical outcome was a 3-month modified Rankin score.
A total of 94 patients were included with 53 in the IVT group and 41 in the non-IVT group. There was no significant difference in age, gender, hypertension, diabetes, atrial fibrillation, acute NIHSS, and last known well time from stroke to CT perfusion acquisition between the two groups. The core growth rate in the IVT group was lower than that in the non-IVT group, which was statistically significant after multivariate adjustment (coefficient: -5.20, 95% CI= [-9.85, -0.56], = 0.028). There was a significant interaction between the IVT and the collateral index in predicting the core growth rate. The analysis was then stratified according to the collateral index, and the results suggested that IVT reduced the core growth rate more significantly after the worsening of collateral circulation (coefficient: 15.38, 95% CI= [-26.25, -4.40], = 0.007). The 3-month modified Rankin score and 24 h-ASPECTS were not statistically significant between the two groups.
Intravenous thrombolysis reduces the core growth rate in patients with AIS, especially those with poor collateral status.
本研究旨在探讨重组组织型纤溶酶原激活剂静脉溶栓（IVT）对急性缺血性卒中核心生长率的影响。
本研究回顾性纳入了接受IVT治疗后出现大血管闭塞且未再通的卒中患者，并将其分为两组：IVT组和非IVT组。核心生长率通过灌注CT上的急性核心体积除以从卒中到CT灌注的最后已知正常时间来估算。主要终点是核心生长率，组织结局是24小时脑缺血半暗带评分（ASPECTS），临床结局是3个月改良Rankin评分。
共纳入94例患者，IVT组53例，非IVT组41例。两组在年龄、性别、高血压、糖尿病、心房颤动、急性国立卫生研究院卒中量表（NIHSS）评分以及从卒中到CT灌注采集的最后已知正常时间方面无显著差异。IVT组的核心生长率低于非IVT组，多因素调整后具有统计学意义（系数：-5.20，95%可信区间=[-9.85，-0.56]，P=0.028）。在预测核心生长率方面，IVT与侧支循环指数之间存在显著交互作用。然后根据侧支循环指数进行分层分析，结果表明在侧支循环恶化后，IVT更显著地降低了核心生长率（系数：15.38，95%可信区间=[-26.25，-4.40]，P=0.007）。两组之间3个月改良Rankin评分和24小时ASPECTS无统计学差异。
静脉溶栓可降低急性缺血性卒中患者的核心生长率，尤其是侧支循环状态较差的患者。
