颈内动脉夹层患者的静脉溶栓治疗：STOP-CAD 研究的二次分析。
Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.
机构信息
From the Department of Neurology (L.S., F. Akpokiere, D.M.M., K.P., V.D., K.B., T.M.B., N.S.K., F. Khan, C.S., N. Mohammadzadeh, E.D.G., K.F., S. Yaghi), Warren Alpert Medical School of Brown University, Providence, RI; Vancouver Stroke Program (T.S.F., L.Z., P.G.), Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Neurology (C.R.L.G.), Atrium Health, Charlotte, NC; Department of Neurology (J. Muppa, N.H.), University of Massachusetts Chan Medical School, Worcester; Department of Neurology (M. Affan, O.U.H.L.), University of Minnesota, Minneapolis; Department of Neurology (M.R.H., K.A., D.J.S., M. Arnold), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.S.O., R. Crandall), University of Colorado, Denver; Department of Neurology (E.L.), Weill Cornell Medicine, New York; ; Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez (D.L.-M., A. Arauz), Mexico City, Mexico; Service de neurologie (A.N., M.B., E.T.), Université Caen Normandie, CHU Caen Normandie, France; Department of Neurology (J.A.S., J.S.-F., V.B.), Coimbra University, ; Department of Internal Medicine (P.C.-C., M.T.B.), São João University Hospital, Porto, Portugal; Department of Neurology (M.K., D.M.), Corewell Health, Grand Rapids, MI; Department of Neurology (M.K.), Mayo Clinic, Rochester, MN; Department of Neurology (A.R., O.K.), University of Pennsylvania, Philadelphia; Neurology and Neurorehabilitation (J.E.K., S.T.E., C.T.), University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland; Stroke Center (D.A.d.S.), Centro Hospitalar Universitário Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa; Department of Neurology (M.D.S.); Department of Neuroradiology (S.B.R.), Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Vancouver Stroke Program (S. Mancini), Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Neurology (I.M., R.R.L.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurology with Experimental Neurology (R.V.R., C.H.N.), Charite Universitätsmedizin-Berlin and Center for Stroke Research, Berlin, and Berlin Institute of Health, Germany; Department of Neurosciences (R. Choi, J. MacDonald), ChristianaCare, Newark, DE; Department of Neurology (R.B.S.), University of California at San Diego; Department of Neurology (X.G.), Loma Linda University, Loma Linda, CA; Department of Neurology (M. Ghannam, M. Almajali, E.A.S.), University of Iowa, Iowa City; Department of Neurosciences (B.R., F.Z.-E., A.P.), Université de Montréal, Canada; Department of Neurology (A.C.F., M.F.B., D.C.), Hospital de Santa Maria, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal; Neurology and Stroke Unit (M. Romoli, G.D.M., M.L.), Department of Neuroscience, Bufalini Hospital, Cesena, Italy; Department of Neurology (Z.K., K.J.G.), Mayo Clinic, Rochester, MN; Department of Neurology (L.K., J.A.F.), NYU Langone Health, New York; Department of Neurology (J.Y.A., J.A.G.), Washington University, Saint Louis, MO; Neurology Unit, Stroke Unit (M. Zedde, I.G.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Internal Medicine (H.N.), Centro Hospital Universitario do Algarve, Faro, Portugal; Department of Neurology (D.S.L., A.M.), University of California at Los Angeles; Department of Neurology (A.C., B.M.G., R.W.), Duke University, Durham, NC; Department of Neurology (W.K.), University of North Carolina Health Rex, Raleigh; Department of Neurology (S.A.K., M. Anadani), Medical University of South Carolina, Charleston, SC; Department of Neurosurgery (K.P.K.), Medical University of South Carolina, Charleston, SC; Department of Neurology (A.E., L.C., R.C.R., Y.N.A., E.A.M.), University of Cincinnati Medical Center, OH; Department of Neurology (E.B., T.L.T.), University of Alabama at Birmingham; Department of Neurology (M.R.-G., M. Requena), University Hospital Vall d'Hebron, Barcelona, Spain; Department of Neurology (F.G.S.V., J.O.G.), University of Oklahoma; Department of Neurology (V.M.), Einstein-Jefferson Healthcare Network, Philadelphia, PA; Department of Neurology (A.H.), University of Utah, Salt Lake City; Department of Neurology (A.H.); Department of Neurology (S. Sanchez, A.S.Z., Y.K.C., R.S.), Yale New Haven Hospital, New Haven, CT; Department of Neurology (V.Y.V.), All India Institute of Medical Sciences, New Delhi, India; Department of Neurology (S. Yaddanapudi, L.A., A. Browngoehl), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (T.R., R.D., Z.L.), Wake Forest Medical Center, NC; Department of Neurology (M.P., J.E.S.), Cooper University, Camden, NJ; Department of Neurology (S. Mayer, J.Z.W.), Columbia University Medical Center, New York, NY; Department of Neurology (J.P.M., D.K.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (P.K., T.N.N.), Boston Medical Center, MA; Department of Neurology (S.D.A., Z.S., A. Balabhadra, S.P.), Hartford Hospital, CT; Department of Neurology (T.S.), Hospital Moinhos de Vento; Department of Neurology (S.C.M., G.P.M.), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Neurology (Y.D.K.), Yonsei University, Seoul, South Korea; Department of Neurology (B.K., C.E.), University of Tennessee at Memphis; Department of Neurology (S. Lingam, A.Y.Q.), Kansas University Medical Center, Kansas City; Department of Neurology (S.F., A. Alvarado), Western Ontario University, London, Canada; Department of Neurology (F. Khasiyev, G.L.), Saint Louis University, MO; Department of Neurology and Stroke Unit (M.M., V.T.), AOOR Villa Sofia-V. Cervello, Palermo, Italy; First Department of Neurology (A.T., V.T.-P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (M.M.M.-M., V.C.W.), Centro Médico Nacional Siglo XXI IMSS., México City; Department of Neurology (F.I., S.E.E.J.), The Miriam Hospital, Providence, RI; Department of Neurocritical Care (S. Liu, M. Zhou), The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology, Hefei, China; Department of Neurology (M.M.A., F. Ali, M.S.), West Virginia University, WV; Department of Neurology (R.Z.M., T.K.-H.), University of Chicago, IL; Department of Neurology (F.S., J.Z.), Sir Run Run Shaw Hospital of Zhejiang University Medical School, Hangzhou, China; Department of Neurology (D.S., J.S., N. Mongare), Aga Khan University, Nairobi, Kenya; Department of Neurology (A.N.S., R.G., Shayak Sen), Cedars Sinai Medical Center, Los Angeles, CA; Department of Neurology (M. Ghani, M.E.), University of Louisville, KY; and Department of Economics (H.X.), University of California, Santa Barbara.
出版信息
Neurology. 2024 Oct 8;103(7):e209843. doi: 10.1212/WNL.0000000000209843. Epub 2024 Sep 19.
OBJECTIVES
Cervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms.
METHODS
This analysis used data from the retrospective STOP-CAD study and included patients with spontaneous CeAD who presented within 1 day of acute ischemic stroke symptoms. Patients were dichotomized into those who received IVT and those managed without IVT. We assessed the association between IVT and 90-day functional independence (modified Rankin Scale scores 0-2) and the incidence of symptomatic intracranial hemorrhage (ICH, defined as ICH causing new or worsening neurologic symptoms within 72 hours after CeAD diagnosis).
RESULTS
This study included 1,653 patients from the original STOP-CAD cohort of 4,023. The median age was 49 years, and 35.1% were women; 512 (31.0%) received IVT. IVT was associated with 90-day functional independence (adjusted odds ratio [aOR] = 1.67, 95% CI 1.23-2.28, = 0.001), but not with symptomatic ICH (aOR = 1.52, 95% CI 0.79-2.92, = 0.215).
DISCUSSION
In patients with spontaneous CeAD and suspected ischemic stroke, IVT improved functional outcomes, without increasing symptomatic ICH risk. These findings support current guideline recommendations to consider thrombolysis for otherwise eligible patients with CeAD.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.
目的
颈内动脉夹层（CeAD）占青年缺血性脑卒中的 25%。本研究评估了接受静脉溶栓（IVT）治疗的自发性 CeAD 伴急性缺血性脑卒中症状患者的获益和风险。
方法
本分析使用回顾性 STOP-CAD 研究的数据，纳入发病 1 天内的自发性 CeAD 伴急性缺血性脑卒中症状患者。将患者分为接受 IVT 治疗组和未接受 IVT 治疗组。评估 IVT 与 90 天功能独立性（改良 Rankin 量表评分 0-2）和症状性颅内出血（ICH，定义为 CeAD 诊断后 72 小时内发生的导致新的或恶化的神经症状的 ICH）发生率之间的关联。
结果
本研究纳入了原始 STOP-CAD 队列中 4023 例患者中的 1653 例。患者中位年龄为 49 岁，35.1%为女性；512 例（31.0%）接受 IVT。IVT 与 90 天功能独立性相关（调整后的优势比 [aOR] = 1.67，95%置信区间 [CI] 1.23-2.28， = 0.001），但与症状性 ICH 无关（aOR = 1.52，95% CI 0.79-2.92， = 0.215）。
讨论
在自发性 CeAD 和疑似缺血性脑卒中患者中，IVT 提高了功能结局，而不增加症状性 ICH 风险。这些发现支持当前指南建议，对符合条件的 CeAD 患者考虑溶栓治疗。
证据分类
本研究提供了 III 级证据，表明 IVT 显著增加了 CeAD 患者 90 天功能独立性的概率。
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