Chen Kechun, Liu Min, Zhang Wenjun, Li Zhengduo, Shi Huimin
Department of Neurology, Zhangjiagang Hospital Affiliated to Soochow University, Zhangjiagang, China.
Neurol Sci. 2025 Mar 19. doi: 10.1007/s10072-025-08109-7.
To investigate early treatment strategies for patients with mild acute ischemic stroke and large vessel occlusion, we evaluated the efficacy of intravenous thrombolysis in patients with mild stroke and large vessel occlusion in different hypoperfusion volumes.
Cohort data of consecutive patients (October 2021 to June 2024) with anterior circulation large vessel occlusion mild stroke (NIHSS ≤ 5) with onset < 24 h were retrospectively analyzed. We compared the outcomes of patients treated with intravenous thrombolysis (IVT) and dual antiplatelet therapy (DAPT). The outcomes of patients on IVT and DAPT were then compared between the large-volume hypoperfusion group (> 65 ml) and the small-volume hypoperfusion group (≤ 65 ml) based on the hypoperfusion volume of CT perfusion (Tmax > 6s).
A total of 222 patients were enrolled in the study (62 IVT, 160 DAPT). In 111 patients with small-volume hypoperfusion, there was no statistically significant difference in the rate of good prognosis (mRS0-1) at 90 days, the rate of early neurological deterioration and the rate of intracranial hemorrhage between the IVT and DAPT groups (P > 0.05). In another 111 patients with large-volume hypoperfusion, the IVT group had a higher rate of good prognosis (mRS0-1) at 90 days (OR:3.639,95%CI:1.249 ~ 10.601, P:0.018) and a higher rate of intracranial hemorrhage (OR:11.029, 95%CI:1.015 ~ 119.873, P:0.049) compared to the DAPT group.
In mild acute ischemic stroke patients with large-volume hypoperfusion and large-vessel occlusion, IVT has a higher rate of intracranial hemorrhage but a higher proportion of excellent functional outcomes compared with DAPT. Further randomized controlled trials are needed.
为了研究轻度急性缺血性卒中合并大血管闭塞患者的早期治疗策略，我们评估了静脉溶栓在不同低灌注体积的轻度卒中和大血管闭塞患者中的疗效。
回顾性分析2021年10月至2024年6月连续收治的前循环大血管闭塞性轻度卒中（美国国立卫生研究院卒中量表[NIHSS]≤5）且发病时间<24小时患者的队列数据。我们比较了接受静脉溶栓（IVT）和双重抗血小板治疗（DAPT）患者的结局。然后根据CT灌注的低灌注体积（Tmax>6秒），比较IVT组和DAPT组在大体积低灌注组（>65ml）和小体积低灌注组（≤65ml）患者中的结局。
本研究共纳入222例患者（62例接受IVT，160例接受DAPT）。在111例小体积低灌注患者中，IVT组和DAPT组在90天时的良好预后率（改良Rankin量表[mRS]0-1）、早期神经功能恶化率和颅内出血率方面无统计学差异（P>0.05）。在另外111例大体积低灌注患者中，与DAPT组相比，IVT组在90天时具有更高的良好预后率（mRS0-1）（比值比[OR]：3.639，95%置信区间[CI]：1.249～10.601，P：0.018）和更高的颅内出血率（OR：11.029，95%CI：1.015～119.873，P：0.049）。
在轻度急性缺血性卒中大体积低灌注合并大血管闭塞患者中，与DAPT相比，IVT颅内出血率更高，但功能结局优秀比例更高。需要进一步开展随机对照试验。
