Ishihara Hideaki, Kohyama Shinya, Nishida Sho, Kumagai Kosuke, Hayashi Shinji, Kato Hiroshi
Department of Neurosurgery, Ken-o-tokorozawa Hospital, Tokorozawa, Saitama, Japan.
Division of Endovascular Neurosurgery, Stroke Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
J Neuroendovasc Ther. 2024;18(8):207-212. doi: 10.5797/jnet.oa.2024-0007. Epub 2024 Jun 8.
Reperfusion therapy, such as intravenous tissue-plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke, may increase the incidence of acute symptomatic seizure (ASS) and post-stroke epilepsy (PSE). This study aimed to analyze the effect and predictors of reperfusion therapy for ASS and PSE limited to large-vessel occlusions (LVOs).
This retrospective study classified 237 subjects with LVO into four groups: (1) IV-tPA + MT+ (n = 74 cases, (2) MT only (n = 82), (3) tissue-plasminogen activator (tPA) only (n = 28), and (4) IV-tPA - MT- (n = 53). The incidences of ASS and PSE were assessed. Potential predictors, such as etiology, functional disability, neuroimaging findings, and the SeLECT score, were statistically analyzed.
There were 12 (5.1%) subjects with ASS and 10 subjects (4.2%) with PSE. The IV-tPA and MT groups had significantly high reperfusion rates, with a Thrombolysis in Cerebral Infarction score ≥2c ( = 0.01) but there were no significant differences in the increases of hemorrhagic transformation, ASS, and PSE. An Alberta Stroke Program Early Computed Tomography Score <6 was a significant predictor of ASS ( = 0.01), and an infarct volume >60 ml was a significant predictor of PSE ( = 0.01).
Reperfusion therapy for acute LVO was not found to increase the risk of ASS and PSE. Large-sized infarctions should be treated with care in PSE.
再灌注治疗，如用于急性缺血性卒中的静脉注射组织型纤溶酶原激活剂（IV-tPA）和机械取栓术（MT），可能会增加急性症状性癫痫（ASS）和卒中后癫痫（PSE）的发生率。本研究旨在分析仅限于大血管闭塞（LVO）的ASS和PSE再灌注治疗的效果及预测因素。
这项回顾性研究将237例LVO患者分为四组：（1）IV-tPA+MT+组（n=74例），（2）单纯MT组（n=82例），（3）单纯组织型纤溶酶原激活剂（tPA）组（n=28例），以及（4）IV-tPA-MT-组（n=53例）。评估ASS和PSE的发生率。对病因、功能残疾、神经影像学表现和SeLECT评分等潜在预测因素进行统计学分析。
有12例（5.1%）患者发生ASS，10例（4.2%）患者发生PSE。IV-tPA组和MT组的再灌注率显著较高，脑梗死溶栓评分≥2c（P=0.01），但在出血转化、ASS和PSE的增加方面无显著差异。阿尔伯塔卒中项目早期计算机断层扫描评分<6是ASS的显著预测因素（P=0.01），梗死体积>60 ml是PSE的显著预测因素（P=0.01）。
未发现急性LVO的再灌注治疗会增加ASS和PSE的风险。对于PSE患者，应谨慎处理大面积梗死。
