Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy
Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy
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DOI：
10.1007/s10072-018-3486-z
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发表时间：
2018-10-01
影响因子：
3.3
通讯作者：
Manganotti, Paolo
中科院分区：
文献类型：
--
作者：
Caruso, Paola;Naccarato, Marcello;Manganotti, Paolo
目的缺血性脑卒中是一种神经急症，溶栓和取栓治疗效果显著。最近，观察性研究使人们对觉醒性卒中的临床和影像学特征有了深入的了解，这对高达25%的缺血性卒中患者感兴趣。在临床实践中，唤醒中风通常不考虑再灌注治疗。本研究的目的是探讨CT灌注成像在清醒脑卒中患者中的应用，并评估CT灌注图提供的神经影像学信息对溶栓和血栓切除术的疗效和安全性的影响。（13 F/9 M平均年龄），在通过CT灌注成像评估合格性后接受再灌注治疗结果平均国立卫生研究院卒中量表（NIHSS）入院时为8.1 ± 4.9，出院时为3.3 ± 5.1，与入院时比较有显著性差异（P < 0.001）。多达10例患者出院时mRS低于3。5例患者发生颅内出血，仅2例患者症状加重（NIHSS评分下降4分），其中1例死亡。结论本研究的主要发现是，通过CT灌注进行充分选择的唤醒卒中可能有利于再灌注治疗。
Objective Ischemic stroke is a neuroemergency condition highly treatable with thrombolysis and thrombectomy. Recently, observational studies have brought insights into clinical and imaging characteristics of wake-up stroke, which interested up to 25% of ischemic stroke patients. In clinical practice, wake-up strokes are usually not considered for reperfusion therapy. The aim of this study was to investigate the use CT perfusion imaging in patients with wake-up stroke and to assess the effect of neuroimaging information provided by CT perfusion maps on the efficacy and safety of thrombolysis and thrombectomy.Patients and method We studied 22 wake-up stroke (WUS) patients (13F/9M mean age) who underwent reperfusion therapy after the eligibility assessed by the CT perfusion imaging (< 50% core-to-penumbra ratio and negative CT perfusion).Results Mean National Institutes of Health Stroke Scale (NIHSS) was 8.1 +/- 4.9 at admission while 3.3 +/- 5.1 at discharge, significantly different from admission (p < 0.001). As many as ten patients had mRS lower than 3 at discharge. Intracranial hemorrhage occurred in five patients and caused symptoms worsening only in two patients (decrease of NIHSS score of 4 points) of which one patient died.Conclusion The main finding of this study is that wake-up stroke with adequate selection by CT perfusion may benefit reperfusion treatment.