Usefulness of ADAMTS13 to predict response to recanalization therapies in acute ischemic stroke
Usefulness of ADAMTS13 to predict response to recanalization therapies in acute ischemic stroke
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DOI：
10.1212/wnl.0000000000005162
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发表时间：
2018-03-20
期刊：
影响因子：
9.9
通讯作者：
Montaner, Joan
中科院分区：
文献类型：
--
作者：
Bustamante, Alejandro;Ning, MingMing;Montaner, Joan
目的分析ADAMTS13（一种具有血小板反应蛋白1型基序的崩解素和金属蛋白酶，成员13）与静脉组织纤溶酶原激活剂（tPA）治疗患者动脉再通的关系，以及与机械取栓治疗患者动脉再通无效的关系。方法选择经IV-tPA治疗动脉闭塞的急性缺血性脑卒中患者108例。采用ELISA法测定治疗前样品中ADAMTS13的活性。2小时经颅多普勒评估再通情况。在78例连续接受血管内取栓治疗的患者中，采用ELISA检测ADAMTS13抗原，无效再通定义为完全再通加上3个月时改良Rankin量表评分bb0.2。再通和无效再通的独立预测因子通过逻辑回归确定，并根据年龄、NIH卒中量表评分和卒中发生时间进行调整。结果实现tpa诱导再通的患者具有更高的基线ADAMTS13活性（78.1% [68%-88%]vs 70.1% [61%-79%], p = 0.021）。在logistic回归分析中，ADAMTS13活动>75%是再通的独立预测因子（优势比= 6.76 [1.52-30.02],p = 0.012），以及缺乏早期缺血迹象和牛津郡社区卒中项目分类。在血管内治疗方面，ADAMTS13浓度降低(
ObjectiveWe aimed to analyze ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) in relation to arterial recanalization in patients treated with IV tissue plasminogen activator (tPA) and in relation to futile recanalization in patients treated with mechanical thrombectomy.MethodsAcute ischemic stroke patients (n = 108) with documented arterial occlusions treated with IV-tPA were selected. ADAMTS13 activity was measured by ELISA in samples collected before treatment. Recanalization was assessed at 2 hours by transcranial Doppler. In 78 consecutive patients treated with endovascular thrombectomy, ADAMTS13 antigen was measured by ELISA and futile recanalization was defined as complete recanalization plus modified Rankin Scale score >2 at 3 months. Independent predictors of recanalization and futile recanalization were determined by logistic regression, adjusted by age, NIH Stroke Scale score, and time from stroke onset.ResultsPatients who achieved tPA-induced recanalization had higher baseline ADAMTS13 activity (78.1% [68%-88%] vs 70.1% [61%-79%], p = 0.021). In logistic regression analysis, ADAMTS13 activity >75% was an independent predictor of recanalization (odds ratio = 6.76 [1.52-30.02], p = 0.012), together with absence of early ischemic signs and Oxfordshire Community Stroke Project classification. Regarding endovascular therapies, a reduced ADAMTS13 concentration (