Annus Ádám, Halmai Nikolett, Fehér Evelin, Tárkányi Gábor, Szapáry László, Szegedi István, Csiba László, Vécsei László, Sztriha László, Klivényi Péter
University of Szeged, Albert Szent-Györgyi Health Centre, Department of Neurology, H-6725 Szeged, Semmelweis u. 6, Hungary.
University of Szeged, Department of Physiology, Anatomy and Neuroscience, H-6726 Szeged, Közép fasor 52, Hungary.
J Stroke Cerebrovasc Dis. 2025 Apr;34(4):108245. doi: 10.1016/j.jstrokecerebrovasdis.2025.108245. Epub 2025 Jan 29.
Thrombolysis (IVT) is effective in the treatment of lacunar stroke (LAC). However, most studies compared the outcome of LAC to a heterogenous control group. We aimed to compare early neurological improvement (ENI) and late functional outcomes following thrombolysis for LAC with a homogenous control group of cardioembolic stroke (CE) without large-vessel occlusion (LVO).
Patient data were obtained from the national multicentre STAY ALIVE Acute Stroke Registry. At each centre, a team of vascular neurologists determined the TOAST classification. ENI was defined as a minimum 4-point decrease in the NIHSS score between admission and discharge, or a complete resolution of symptoms. For late functional outcome, we analysed the dichotomised 90-day mRS scores (good outcome was mRS≤2).
142 LAC and 156 CE patients were analysed. Following IVT, the percentage of ENI did not differ significantly (LAC 41.1% vs CE 49.7%, p=0.154), and multivariable analysis did not identify any clinical parameters that would predict ENI after IVT in either group. LAC patients had unfavourable, albeit non-significant, odds of having good 90-day functional outcomes compared to CE patients (aOR 0.483, 95% CI 0.201-1.161, p=104).
We report the first analysis of short- and long-term outcomes of IVT in LAC, using a homogenous control group of CE patients without LVO. The prevalence of ENI and 90-day functional outcomes were similar. However, LAC patients had unfavourable odds of achieving good functional outcomes compared to the control group. Therefore, we emphasise that LAC should not be considered a minor stroke subtype.
溶栓治疗（静脉溶栓）对腔隙性卒中（LAC）有效。然而，大多数研究将腔隙性卒中的结果与异质性对照组进行比较。我们旨在将腔隙性卒中溶栓后的早期神经功能改善（ENI）和晚期功能结局与无大血管闭塞（LVO）的心脏栓塞性卒中（CE）同质性对照组进行比较。
患者数据来自全国多中心“STAY ALIVE急性卒中登记处”。在每个中心，由一组血管神经科医生确定TOAST分类。ENI定义为入院和出院之间美国国立卫生研究院卒中量表（NIHSS）评分至少降低4分，或症状完全缓解。对于晚期功能结局，我们分析了二分法的90天改良Rankin量表（mRS）评分（良好结局为mRS≤2）。
分析了142例腔隙性卒中和156例心脏栓塞性卒中患者。静脉溶栓后，早期神经功能改善的百分比无显著差异（腔隙性卒中41.1% vs心脏栓塞性卒中49.7%，p = 0.154），多变量分析未发现任何可预测两组静脉溶栓后早期神经功能改善的临床参数。与心脏栓塞性卒中患者相比，腔隙性卒中患者90天功能结局良好的几率虽不显著但较差（调整后比值比0.483，95%置信区间0.201 - 1.161，p = 0.104）。
我们首次使用无LVO的心脏栓塞性卒中患者同质性对照组，分析了腔隙性卒中静脉溶栓的短期和长期结局。早期神经功能改善和90天功能结局的发生率相似。然而，与对照组相比，腔隙性卒中患者获得良好功能结局的几率较差。因此，我们强调腔隙性卒中不应被视为轻微的卒中亚型。
