Rapidly improving stroke symptoms: a pilot, prospective study.
Rapidly improving stroke symptoms: a pilot, prospective study.
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快速改善中风症状：一项试点前瞻性研究。
DOI：
10.1016/j.jstrokecerebrovasdis.2015.01.017
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Levine,StevenR
中科院分区：
文献类型：
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作者：
Balucani,Clotilde;Bianchi,Riccardo;Ramkishun,Charles;Weedon,Jeremy;Law,Susan;Szarek,Michael;Rojas-Soto,Diana;Tariq,Sara;Levine,StevenR
背景快速改善卒中症状(RISSS)是静脉注射重组组织型纤溶酶原激活剂(rt-PA)治疗急性缺血性卒中(AIS)的一个有争议的排除。我们估计了4种预先指定的RISS定义的频率，并探讨了它们与临床结果的关系。方法试点，前瞻性研究，研究对象为症状出现4.5小时内入院的AIS患者。使用美国国立卫生研究院卒中评定量表(NIHSS)每隔20±5分钟进行一次系列评估，直到做出rt-PA治疗决定，独立于研究。根据基线NIHSS和治疗决策NIHSS之间的差值计算改善程度。RISS被定义为改善4分或更多，25%或更多，50%或更多，并根据先前报道的治疗(重新检查急性溶栓资格)标准。不良结果定义为卒中后90天改良Rankin量表评分大于1。Logistic回归分析RISS定义(S)是否与结果相关。结果纳入50例AIS患者：平均年龄65岁；基线NIHSS评分中位数为5(四分位数范围2-11)。根据定义，RISS频率为10%-22%。治疗决策NIHSS评分中位数为5(四分位数范围2-9)。23例(46%)患者接受了rt-PA治疗。3个非治疗RISS定义中没有一个与结果独立相关。50例中5例(10%)RISS符合治疗标准，5例未经RT-PA治疗效果良好。结论在治疗前进行一系列NIHSS评估是可行的，有助于确定RISS的发生频率和程度。这是根据各种预先指定的定义对RISS频率和结果的第一次前瞻性估计。将RISS频率作为一个更严格的定义可能会在未来的更大规模的研究中更好地预测RISS的良好结果。
BackgroundRapidly improving stroke symptoms (RISSs) are a controversial exclusion for intravenous recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS). We estimated the frequency of 4 prespecified RISS definitions and explored their relationship to clinical outcome.MethodsPilot, prospective study of AIS patients admitted within 4.5 hours of symptom onset. Serial assessments using National Institute of Health Stroke Scale (NIHSS) were performed every 20 ± 5 minutes until a rt-PA treatment decision was made, independent of the study. Improvement was calculated as the difference between baseline NIHSS and treatment decision NIHSS. RISS was defined as a 4-point or greater improvement, 25% or greater, 50% or greater, and according to the previously reported TREAT (The Re-examining Acute Eligibility for Thrombolysis) criteria. Unfavorable outcome was defined as modified Rankin Scale score more than 1 at 90 days after stroke. Logistic regression determined if RISS definition(s) related to the outcome.ResultsFifty patients with AIS were enrolled: mean age 65 years; median baseline NIHSS score 5 (interquartile range, 2-11). RISS frequencies were 10%-22% based on definition. Median treatment decision NIHSS score is 5 (interquartile range, 2-9). Twenty-three (46%) patients received rt-PA. None of the 3 non-TREAT RISS definitions was independently associated with the outcome. Five of fifty (10%) were RISS according to the TREAT criteria, all 5 had good outcome without rt-PA.ConclusionsA Serial NIHSS assessment before treatment decision is feasible and may help determine the frequency and magnitude of RISS. This is the first prospective estimate of RISS frequency and outcome according to various prespecified definitions. The TREAT RISS frequency as a more restrictive definition may better predict good outcome of RISS in future, larger studies.