在符合溶栓条件的急性缺血性中风患者中，对比CT灌注和血管造影与单纯CT的随机对照试验：缺血性中风评估中的半暗带和再通急性计算机断层扫描（PRACTISE）试验

Randomised, controlled Trial of CT perfusion and angiography compared to CT alone in thrombolysis-eligible acute ischaemic stroke patients: The penumbra and recanalisation acute computed tomography in ischaemic stroke evaluation (PRACTISE) trial.

作者信息

Muir Keith W, El Tawil Salwa, McConnachie Alex, Ford Ian, Mair Grant, Khaira Jattinder, Chatterjee Kausik, Sztriha Laszlo, Halse Omid, Balogun Ibrahim, Nayak Sanjeev, White Phil, Warburton Elizabeth A, Wardlaw Joanna

机构信息

School of Cardiovascular & Metabolic Health, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, UK.

Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.

出版信息

Eur Stroke J. 2025 Sep 19:23969873251372348. doi: 10.1177/23969873251372348.

DOI:10.1177/23969873251372348

PMID:40970508

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12449310/

Abstract

INTRODUCTION

The role of CT angiography (CTA) and CT perfusion (CTP) in patient selection for thrombolysis <4.5 h after onset is unclear. Additional imaging may improve specificity of diagnosis by excluding stroke mimics or those without salvageable tissue, but may delay treatment.

PATIENTS AND METHODS

In a multicentre prospective randomised trial, thrombolysis-eligible patients <4.5 h from symptom onset were randomised 1:1 to non-contrast CT (NCCT) or multimodal CT (NCCT + CTA + CTP). The primary endpoint was the proportion receiving thrombolysis. Secondary end-points were times to decision-making and treatment delivery, early neurological recovery, functional recovery at 3 months and incidence of symptomatic intracerebral haemorrhage (SICH).

RESULTS

Between March 2015 and May 2018, 271 patients were randomised, 134 to multimodal CT and 137 to NCCT. After initial NCCT, 114 had no contraindication to thrombolysis in the multimodal CT group and 108 in the NCCT group. Mean age was 67.5 years and median NIHSS score was 6 (interquartile range 3-12). Fewer patients assigned multimodal CT received thrombolysis (56/114, 49.1%) compared to NCCT (73/108, 67.6%, adjusted odds ratio (aOR) 0.46 (95% CI: 0.25-0.83), = 0.0102). Times to treatment decision or thrombolytic administration, early neurological recovery and day 90 functional outcome did not differ significantly. SICH occurred in two patients, both assigned NCCT. Mortality was 6/114 (5.3%) in the multimodal CT group compared to 11/108 (10.2%; aOR 0.46 (95% CI: 0.16, 1.31), = 0.147) in the NCCT group.

DISCUSSION

Despite fewer patients receiving thrombolysis after multimodal imaging, treatment decision times and clinical outcomes did not differ significantly. Multimodal CT may identify patients who do not require thrombolysis such as stroke mimics and non-disabling strokes.

CONCLUSION

Among acute stroke patients imaged <4.5 h from symptom onset, multimodal CT reduced use of thrombolysis. Treatment decision times and clinical outcomes did not differ between groups.

摘要

引言

CT血管造影（CTA）和CT灌注成像（CTP）在发病后<4.5小时患者溶栓治疗选择中的作用尚不清楚。额外的影像学检查可能通过排除类似卒中的疾病或无挽救脑组织的疾病来提高诊断的特异性，但可能会延迟治疗。

患者与方法

在一项多中心前瞻性随机试验中，症状发作<4.5小时符合溶栓条件的患者按1:1随机分为非增强CT（NCCT）组或多模态CT组（NCCT + CTA + CTP）。主要终点是接受溶栓治疗的比例。次要终点是决策时间和开始治疗的时间、早期神经功能恢复、3个月时的功能恢复以及症状性颅内出血（SICH）的发生率。

结果

2015年3月至2018年5月期间，271例患者被随机分组，134例接受多模态CT检查，137例接受NCCT检查。在初始NCCT检查后，多模态CT组有114例无溶栓禁忌证，NCCT组有108例无溶栓禁忌证。平均年龄为67.5岁，美国国立卫生研究院卒中量表（NIHSS）评分中位数为6分（四分位间距3 - 12）。与NCCT组（73/108，67.6%）相比，接受多模态CT检查的患者接受溶栓治疗的较少（56/114，49.1%），调整后的优势比（aOR）为0.46（95%可信区间：0.25 - 0.83），P = 0.0102。治疗决策或溶栓给药时间、早期神经功能恢复以及90天时的功能结局差异均无统计学意义。2例患者发生SICH，均在NCCT组。多模态CT组死亡率为6/114（5.3%），NCCT组为11/108（10.2%；aOR 0.46（95%可信区间：0.16，1.31），P = 0.147）。