Clinical and magnetic resonance imaging predictors of very early neurological response to intravenous thrombolysis in patients with middle cerebral artery occlusion.
Clinical and magnetic resonance imaging predictors of very early neurological response to intravenous thrombolysis in patients with middle cerebral artery occlusion.
复制标题
DOI：
10.1161/jaha.113.000511
复制
发表时间：
2013-12-05
影响因子：
5.4
通讯作者：
Touzé E
中科院分区：
文献类型：
--
作者：
Apoil M;Turc G;Tisserand M;Calvet D;Naggara O;Domigo V;Baron JC;Oppenheim C;Touzé E
早期识别不太可能对静脉内重组组织纤溶酶原激活剂（IV-tPA）产生反应的患者可以帮助选择在中风急性期进行额外动脉内治疗或添加抗血栓药物的候选人。鉴于极早期神经功能改善 (VENI) 是早期再通的可靠替代指标，我们评估了 VENI 缺乏的临床和磁共振成像预测因素。我们回顾了 2003 年至 2012 年间在我们中心连续 4.5 小时内接受 IV-tPA 治疗的大脑中动脉闭塞的缺血性卒中患者，其中系统地实施磁共振成像作为一线诊断检查。缺乏 VENI 被定义为 IV-tPA 开始 1 小时后美国国立卫生研究院卒中量表 (NIHSS) 基线评分下降 <40%。不良结果定义为 3 个月改良 Rankin 量表≥2。在逻辑回归模型中评估了 VENI 缺乏与潜在决定因素之间的关联。总共纳入了 186 名患者（中位基线 NIHSS 评分为 16；中位发病到治疗时间为 155 分钟）。 143 名患者 (77%) 没有 VENI。多变量分析中与缺乏 VENI 显着相关的变量包括基线 NIHSS（OR，1.08；95% CI，每增加 1 点，1.01 至 1.16；P=0.03）、发病至治疗时间 > 120 分钟（OR，2.94；95% CI，1.31 至 6.63；P=0.009）和弥散加权成像 — 艾伯塔省卒中计划早期CT评分≤5 （OR，3.60；95% CI，1.14 至 11.35；P=0.03）。没有 VENI 的患者比没有 VENI 的患者更可能有改良Rankin量表≥2（68% vs 24%；OR，5.01；95% CI，2.12至11.82），并且24小时后再通的可能性更小（OR，0.41；95% CI，0.19至0.88）。缺乏 VENI 可提供 IV-tPA 后 3 个月结果和再通的早期估计。基线 NIHSS、开始治疗时间和弥散加权成像 - 艾伯塔省卒中计划早期 CT 评分有助于预测 VENI 的缺乏，进而可能有助于早期选择补充再灌注策略的候选者。
The early identification of patients who are unlikely to respond to intravenous recombinant tissue plasminogen activator (IV‐tPA) could help select candidates for additional intra‐arterial therapy or add‐on antithrombotic drugs during the acute stage of stroke. Given that very early neurological improvement (VENI) is a reliable surrogate of early recanalization, we assessed the clinical and magnetic resonance imaging predictors of lack of VENI. We reviewed consecutive ischemic stroke patients with middle cerebral artery occlusion and treated within 4.5 hours by IV‐tPA between 2003 and 2012 in our center, where magnetic resonance imaging is systematically implemented as first‐line diagnostic workup. Lack of VENI was defined as a <40% decrease in baseline National Institutes of Health Stroke Scale (NIHSS) score 1 hour after start of IV‐tPA. Poor outcome was defined as a 3‐month modified Rankin scale ≥2. Associations between lack of VENI and potential determinants were assessed in logistic regression models. In all, 186 patients were included (median baseline NIHSS score, 16; median onset to treatment time, 155 minutes). One hundred forty‐three patients (77%) had no VENI. The variables significantly associated with lack of VENI in multivariable analysis were baseline NIHSS (OR, 1.08; 95% CI, 1.01 to 1.16 per 1‐point increase; P=0.03), onset to treatment time >120 minutes (OR, 2.94; 95% CI, 1.31 to 6.63; P=0.009) and diffusion weighted imaging—Alberta Stroke Programme Early CT Score ≤5 (OR, 3.60; 95% CI, 1.14 to 11.35; P=0.03). Patients without VENI were more likely to have a modified Rankin Scale ≥2 than those without VENI (68% versus 24%; OR, 5.01; 95% CI, 2.12 to 11.82) and less likely to have recanalization after 24 hours (OR, 0.41; 95% CI, 0.19 to 0.88). Lack of VENI provides an early estimate of 3‐month outcome and recanalization after IV‐tPA. Baseline NIHSS, onset to treatment time, and diffusion weighted imaging—Alberta Stroke Programme Early CT Score could help to predict lack of VENI and, in turn, might help early selection of candidates for complementary reperfusion strategies.