Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke
Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke
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DOI：
10.1161/01.str.31.8.1812
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发表时间：
2000-08-01
期刊：
影响因子：
8.3
通讯作者：
Grotta, JC
中科院分区：
文献类型：
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作者：
Christou, I;Alexandrov, AV;Grotta, JC
背景-在脑缺血动物模型中，脑血流障碍的持续时间与脑损伤的不可逆性相关。我们的目的是将卒中的临床恢复与静脉注射组织型纤溶酶原激活剂（tPA）治疗后动脉再通的时间相关联。方法：有脑缺血症状的患者在卒中发作后3小时内接受0.9 mg/kg tPA IV治疗（标准方案）或在3 - 6小时接受0.6 mg/kg tPA IV治疗（实验机构审查委员会批准的方案）。在治疗前、tPA输注结束时和24小时获得美国国立卫生研究院卒中量表（NIHSS）评分;在长期随访时获得兰金评分。经颅多普勒（TCD）用于在tPA前定位动脉闭塞并监测再通（Marc头架，Spencer Technologies; Multigon 500 M，DWL MultiDop-T），根据先前开发的标准确定TCD上的再通。结果-研究了40例患者（年龄70+/-16岁，基线NIHSS评分18.6+/-6.2）。在症状发作后132 ± 54分钟给予tPA推注。在卒中发作后平均251+/-171分钟发现TCD再通：12例（30%）患者发生完全再通，15例（40%）患者发生部分再通（最长观察时间360分钟）。75%的再通患者在tPA推注后60分钟内发生再通。再通的时间与下一小时内NIHSS评分的早期改善呈负相关（多项式曲线，三阶r（2）=0.429，P300 minutes. Conclusions-经颅多普勒超声（TCD）测定的tPA治疗后动脉再通的时间与卒中的临床恢复相关，并显示300分钟的窗口期可实现早期完全恢复。这些数据与脑缺血动物模型中的发现平行，并证实了这些模型在预测再灌注治疗反应中的相关性。
Background-The duration of cerebral blood flow impairment correlates with irreversibility of brain damage in animal models of cerebral ischemia. Our aim was to correlate clinical recovery from stroke with the timing of arterial recanalization after therapy with intravenous tissue plasminogen activator (tPA). Methods-Patients with symptoms of cerebral ischemia were treated with 0.9 mg/kg tPA IV within 3 hours after stroke onset (standard protocol) or with 0.6 mg/kg at 3 to 6 hours tan experimental institutional review board-approved protocol). National Institutes of Health Stroke Scale (NIHSS) scores were obtained before treatment, at the end of tPA infusion, and at 24 hours; Rankin Scores were obtained at long-term follow-up. Transcranial Doppler (TCD) was used to locate arterial occlusion before tPA and to monitor recanalization (Marc head frame, Spencer Technologies; Multigon 500M, DWL MultiDop-T), Recanalization on TCD was determined according to previously developed criteria.Results-Forty patients were studied (age 70+/-16 years, baseline NIHSS score 18.6+/-6.2). A tPA bolus was administered at 132+/-54 minutes from symptom onset. Recanalization on TCD was found at the mean time of 251+/-171 minutes after stroke onset: complete recanalization occurred in 12 (30%) patients and partial recanalization occurred in 15 (40%) patients (maximum observation time 360 minutes). Recanalization occurred within 60 minutes of tPA bolus in 75% of patients who recanalized. The timing of recanalization inversely correlated with early improvement in the NIHSS scores within the next hour (polynomial curve, third order r(2)=0.429, P300 minutes.Conclusions-The timing of arterial recanalization after tPA therapy as determined with TCD correlates with clinical recovery from stroke and demonstrates a 300-minute window to achieve early complete recovery. These data parallel findings in animal models of cerebral ischemia and confirm the relevance of these models in the prediction of response to reperfusion therapy.