Efficacy of IV tissue plasminogen activator in acute stroke - Does stroke subtype really matter?
Efficacy of IV tissue plasminogen activator in acute stroke - Does stroke subtype really matter?
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DOI：
10.1212/01.wnl.0000071228.56362.36
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发表时间：
2003-07-08
期刊：
影响因子：
9.9
通讯作者：
Tong, DC
中科院分区：
文献类型：
--
作者：
Hsia, AW;Sachdev, HS;Tong, DC
背景：国家神经疾病和中风研究所（NINDS）试验报告说，中风亚型（例如，大动脉粥样硬化血栓形成、心源性栓塞和腔隙）不影响静脉溶栓治疗的反应。然而，这些结论是基于广泛的诊断评估之前确定的卒中亚型。由于这种初步诊断往往是不准确的，静脉注射重组组织纤溶酶原激活剂（rt-PA）的疗效的基础上验证特定的中风亚型仍然不确定。方法：回顾性分析两个区域卒中中心接受IV rt-PA治疗的连续急性卒中患者的记录。在完整的诊断评估后确定最终的卒中亚型。然后研究最终卒中亚型与溶栓治疗反应之间的关系，并与NINDS试验报告的结果进行比较。结果：研究了90例连续患者。校正基线NIH卒中量表评分后，基于已确认卒中机制的最终结局无显著差异。结论：这些数据与NINDS试验的数据一致，该试验报告3小时时间窗内静脉溶栓的疗效在不同卒中亚型之间相似。基于这些数据，可能不需要根据假定的卒中机制分配IV rt-PA治疗卒中患者。这种测试可能会导致时间延迟，从而影响治疗效果。
Background: The National Institute of Neurological Disorders and Stroke (NINDS) trial reported that stroke subtype (e.g., large-artery atherothrombosis, cardioembolism, and lacunae) does not affect response to IV thrombolytic treatment. However, these conclusions were based upon stroke subtypes determined prior to extensive diagnostic evaluation. Because such initial diagnoses are frequently inaccurate, the efficacy of IV recombinant tissue plasminogen activator (rt-PA) based upon verified specific stroke subtypes remains uncertain. Methods: The records of consecutive acute stroke patients treated with IV rt-PA at two regional stroke centers were retrospectively reviewed. The final stroke subtype after complete diagnostic evaluation was determined. The relationship between final stroke subtype and response to thrombolytic therapy was then investigated and compared with the results reported in the NINDS trial. Results: Ninety consecutive patients were studied. After adjusting for baseline NIH Stroke Scale scores, no significant difference in final outcome based on confirmed stroke mechanism was identified. Conclusions: These data are consistent with those of the NINDS trial that reported that the efficacy of IV thrombolysis within the 3-hour time window is similar between different stroke subtypes. Based upon these data, allocating treatment of stroke patients with IV rt-PA based upon presumed stroke mechanism may be unnecessary. Such testing may result in time delays that could compromise the efficacy of treatment.