Negative fluid-attenuated inversion recovery-based intravenous thrombolysis using recombinant tissue plasminogen activator in acute stroke patients with unknown onset time.
Negative fluid-attenuated inversion recovery-based intravenous thrombolysis using recombinant tissue plasminogen activator in acute stroke patients with unknown onset time.
复制标题
DOI：
10.1159/000348552
复制
发表时间：
2013
影响因子：
1.9
通讯作者：
Sakamoto Y
中科院分区：
文献类型：
--
作者：
Aoki J;Kimura K;Shibazaki K;Sakamoto Y
大约25%的急性脑卒中患者由于发病时间不明，不能使用重组组织型纤溶酶原激活剂静脉溶栓。最近的研究表明，发病时间未知的患者在液体衰减反转恢复（FLAIR阴性）无缺血时可以接受IV-tPA。本研究与标准IV-tPA患者相比，评估了IV-tPA在发病时间未知且FLAIR阴性患者中的安全性和可行性。前瞻性纳入发病时间未知的脑卒中患者。仅对颈内动脉（ICA）和/或大脑中动脉（M1和M2）闭塞且弥散加权成像-阿尔伯塔卒中程序早期CT评分(DWI-ASPECTS)≥5的患者进行分析。如果患者FLAIR呈阴性，则在“首次发现异常时间”后3小时内进行IV-tPA。标准IV-tPA患者在年龄和闭塞动脉与阴性FLAIR （N-F）组匹配后，从我们的注册表中提取作为对照。N-F组20例，对照组60例。美国国立卫生研究院卒中量表（NIHSS）评分[中位数18（四分位间距13-20）比17 (12-20),p = 0.609]和DWI-ASPECTS评分[9（7-9）比8 (5-9),p = 0.213]在两组之间相似。两组中ICA闭塞率为35%，M1闭塞率为50%，M2闭塞率为15%。N-F组无一例出现症状性脑出血，对照组1例（2%）出现症状性脑出血（p = 1.000）。N-F组6例（30%）和对照组24例（40%）患者在IV-tPA后1 h内实现再通（p = 0.595）。N-F组13例（65%）患者在IV-tPA后24 h再通，对照组43例（72%）患者再通（p = 0.584）。第7天，N-F组8例（40%）和对照组28例（47%）显著恢复（定义为NIHSS总分降低≥10分或得分为0或1）（p = 0.796）。3个月时，N-F组有47%的患者预后良好（改良Rankin量表评分0-2），对照组有33% （p = 0.365）。IV-tPA在发病时间未知的FLAIR阴性患者中是安全可行的。
Approximately 25% of acute stroke patients were excluded from intravenous thrombolysis using recombinant tissue plasminogen activator (IV-tPA) because of unknown onset time. Recent studies have shown that patients with unknown onset time would be able to receive IV-tPA when showing no ischemia on fluid-attenuated inversion recovery (negative FLAIR). The present study evaluated the safety and feasibility of IV-tPA in patients with unknown onset time and negative FLAIR compared to those with standard IV-tPA. Stroke patients with unknown onset time were prospectively enrolled. Only patients with an occlusion of the internal carotid artery (ICA) and/or middle cerebral artery (M1 and M2) with a Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥5 were analyzed. IV-tPA was performed within 3 h from the ‘first found abnormal time’ if the patient showed negative FLAIR. Standard IV-tPA patients were extracted from our registry as controls after having been matched by age and occluded artery to the negative FLAIR (N-F) group. Twenty patients in the N-F group and 60 in the control group were included. National Institutes of Health Stroke Scale (NIHSS) scores [median 18 (interquartile range 13-20) vs. 17 (12-20), p = 0.609] and DWI-ASPECTS [9 (7-9) vs. 8 (5-9), p = 0.213] were similar between the 2 groups. ICA occlusion was seen in 35%, M1 in 50%, and M2 in 15% in both groups. None of the N-F group and 1 (2%) of the control group experienced symptomatic intracerebral hemorrhage (p = 1.000). Recanalization within 1 h after IV-tPA was achieved in 6 (30%) patients in the N-F group and 24 (40%) in the control group (p = 0.595). Recanalization at 24 h after IV-tPA was seen in 13 (65%) patients in the N-F group and 43 (72%) in the control group (p = 0.584). At 7 days, 8 (40%) in the N-F group and 28 (47%) in the control group had a dramatic recovery (defined as a ≥10-point reduction in the total NIHSS score or a score of 0 or 1) (p = 0.796). At 3 months, a favorable outcome (modified Rankin scale score, 0-2) was seen in 47% in the N-F group and 33% in the control group (p = 0.365). IV-tPA in negative FLAIR patients with unknown onset time appears safe and feasible.