Revascularization end points in stroke interventional trials - Recanalization versus reperfusion in IMS-I
Revascularization end points in stroke interventional trials - Recanalization versus reperfusion in IMS-I
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DOI：
10.1161/01.str.0000185698.45720.58
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发表时间：
2005-11-01
期刊：
影响因子：
8.3
通讯作者：
Tomsick, T
中科院分区：
文献类型：
--
作者：
Khatri, P;Neff, J;Tomsick, T
背景和目的--急性卒中文献缺乏关于血运重建关键终点的标准约定。两个不同的参数可能在临床上很重要：(1)原发性动脉闭塞病变(AOL)的再通；(2)远端血管床的全面再灌注。我们试图在介入治疗卒中(IMS)静脉(IV)和动脉(IA)联合应用重组组织型纤溶酶原激活剂(IA)的I期试验中确定它们之间的关系。方法：对61例血管造影进行再通和再灌流评分。AOL评分为：0=原发闭塞无再通，I=原发闭塞不完全或部分再通但无远端血流，II=原闭塞不完全或部分再通伴远端再通，III=原闭塞完全再通伴远端再通。心肌梗死溶栓(TIMI)评分为：0=无灌注，1=超过首次闭塞但无远端分支充盈，2=有灌注但远端分支充盈不全或缓慢，或3=完全灌注并全部远端分支充盈。结果：AOL和TIMI评分有较好的一致性(kappa，0.30；可信区间0.16~0.44)。AOL II/III评分优良率为49%(P=0.055)，TIMI2/3评分优良率为54%(P=0.019)。两种方法在预测预后方面无显著差异(P=0.13)。结论：在这种治疗模式下，AOL再通和TIMI再灌注评分可以比较地预测临床结果。其他形式可能显示这两个血运重建终点之间的不同关系。未来的研究应该在语义和方法上区分这些参数。
Background and Purpose - The acute stroke literature lacks a standard convention regarding the critical end point of revascularization. Two distinct parameters may be clinically important: (1) recanalization of the primary arterial occlusive lesion (AOL) and (2) global reperfusion of the distal vascular bed. We sought to determine their relationship in the Interventional Management of Stroke (IMS) Phase I trial of combined intravenous (IV) and intraarterial (IA) recombinant tissue plasminogen activator.Methods - Sixty-one angiograms were reanalyzed using recanalization and reperfusion scores. The AOL Score was defined as: 0 = no recanalization of the primary occlusion, I = incomplete or partial recanalization of the primary occlusion with no distal flow, II = incomplete or partial recanalization of the primary occlusion with distal flow, or III = complete recanalization of the primary occlusion with distal flow. The Thrombolysis in Myocardial Infarction (TIMI) Score was defined as: 0 = no perfusion, 1 = perfusion past the initial occlusion but no distal branch filling, 2 = perfusion and incomplete or slow distal branch filling, or 3 = full perfusion with filling of all distal branches. We compared the 2 scores with one another and with good clinical outcome (modified Rankin Score zero to 2).Results - AOL and TIMI scores showed modest agreement (kappa, 0.30; confidence interval, 0.16 to 0.44). Good clinical outcome was seen in 49% of patients with AOL II/III scores (P = 0.055) and 54% with TIMI 2/3 scores (P = 0.019). The 2 methods did not significantly differ in predicting outcome (P = 0.13).Conclusions - AOL recanalization and TIMI reperfusion scores comparably predict clinical outcome in this treatment paradigm. Other modalities may show different relationships between these 2 revascularization end points. Future studies should distinguish between these parameters semantically and methodologically.