选择性动脉溶栓治疗急性脑梗死的对照研究

目的评价选择性动脉溶栓治疗急性脑梗死的疗效和安全性。方法2003年1月～2005年5月期间对25例急性脑梗死患者进行选择性动脉溶栓,同期选择年龄、病情相匹配的无溶栓的对照患者25例,同时采用卒中登记方法收集选择性动脉溶栓患者及同期无溶栓的对照患者的临床、实验室及影像学等资料,前瞻性随访所有患者6个月的预后。结果溶栓组和对照组1个月末的病死率分别为4%和4%,6个月末的病死率分别为4%和4%;溶栓组和对照组1个月末残疾率分别为16%和40%,6个月末的残疾率分别为4%和24%。溶栓组并发脑出血2例(8%),其中症状性脑出血1例(4%);对照组未发生症状性脑出血。结论选择性动脉溶栓治疗急性脑梗死患者有效和安全。     

缺血性脑卒中超早期选择性动脉溶栓治疗

目的评价超早期选择性脑动脉溶栓疗法(SIT)对急性缺血性脑卒中的疗效及安全性.方法32例急性缺血性脑卒中患者起病至溶栓时间介于1～6小时.尿激酶用量87.66±17.63万单位.溶栓前先用微导丝通过血栓到达血栓远端,导丝撤出后,将导管置于靶血管闭塞点或患侧颈内动脉进行溶栓治疗.结果颈内动脉闭塞12例,3例完全再通,2例部分再通.大脑中动脉闭塞20例,19例完全再通.治疗后3个月神经功能恢复率为81%(26/32).4例合并无症状性脑出血均痊愈.血管再闭塞1例(经重复造影证实).结论超早期SIT治疗可使闭塞血管再通.溶栓后并发无症状性脑出血患者临床可恢复正常.SIT是目前治疗急性缺血性脑卒中有效的治疗手段.     

急性缺血性脑卒中超选择动脉溶栓疗法的并发症分析

急性缺血性脑卒中超选择动脉溶栓疗法的并发症分析郑加生崔雄伟赵永春李华徐均超赵家壁魏岗之急性缺血性脑卒中在急诊临床中较为常见。目前溶栓治疗日益受到重视，但溶栓治疗中存在一定的并发症，如脑出血等。本文报告５０例急性缺血性脑卒中进行超选择性动脉溶栓治疗后并...     

超选择性动脉溶栓治疗急性后循环缺血性卒中疗效观察

目的 本研究旨在探讨超选择性动脉溶栓治疗急性后循环缺血性卒中的有效性及安全性.方法 41例急性后循环卒中患者给予尿激酶超选择性动脉内接触溶栓,观察溶栓前、溶栓后24 h NIHSS、GCS评分变化,3个月时Barthel评分情况,溶栓后闭塞血管的再通及症状性脑出血等情况.结果 41例患者中脑血管造影有狭窄或闭塞者32例,溶栓后狭窄血管成功再通25(78.1%),血管未再通7例(21.9%);再通的病例中5例再通后残余狭窄严重,同期给予支架成形术.溶栓后24 h较溶栓前NIHSS评分明显降低(14.83±6.69 vs 18.20±4.19,P＜0.05),而GCS评分明显提高(10.63±3.73 vs 8.78±1.77,P＜0.05);3个月时日常生活能力指数(Barthel index,BI)≥60者达65.9%;溶栓并发脑出血5例,其中症状性脑出血3例,均死亡.结论 尿激酶超选择性动脉内接触溶栓治疗急性后循环缺血性卒中安全、有效.     

动脉内溶栓治疗急性缺血性脑卒中的临床分析

目的:探讨使用动脉内溶栓方法治疗急性缺血性脑卒中的效果。方法:回顾138例急性缺血性脑卒中患者,发病距接受治疗的时间为3～24h,采取超选择性动脉溶栓。结果:颈内动脉闭塞22例,大脑中动脉主干闭塞38例,大脑中动脉分支闭塞33例,大脑前动脉闭塞1例,椎基底动脉系统血管闭塞12支。脑血管造影未见异常32例。闭塞血管再通者,颈内动脉12例;大脑中动脉24例;大脑中动脉分支21例;椎基底动脉8例。8例患者因明显血管狭窄,治疗后予以球囊扩张,支架植入术。临床症状完全恢复或明显好转83例,溶栓后脑出血患者5例。结论:超选择动脉内溶栓是治疗急性缺血性脑卒中的有效方法。     

急性大脑中动脉缺血性卒中的早期局部动脉溶栓治疗

目的评估早期使用尿激酶(UK)局部动脉溶栓治疗急性大脑中动脉(MCA)缺血性脑卒中的安全性和疗效.方法16例急性大脑中动脉缺血性卒中患者发病6 h内接受UK局部动脉溶栓治疗,溶栓后90天评估MRS.结果12例患者(75%)获得良好临床转归,4例患者临床转归差,无患者死亡.2例患者发生症状性脑出血(12.5%).12例患者获得血管再通,其中11例获得良好临床转归(P=0.011).11例患者24h神经功能改善,均获得良好临床转归(P=0.004).结论初步结果表明急性大脑中动脉缺血性卒中的患者接受早期尿激酶局部动脉溶栓治疗是安全、有效的,需进一步积累病例和随访研究.     

急性大脑中动脉脑梗死动脉溶栓治疗临床分析

目的评价超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效和安全性。方法选择发病6h内的急性脑梗死患者51例,其中动脉溶栓组21例,接受脑血管造影证实为大脑中动脉急性闭塞并进行超选择性动脉溶栓治疗;常规治疗组30例,给予巴曲酶降纤治疗。观察两组NIHSS、Barthel指数(barthel index,BI),并进行疗效评定。结果动脉溶栓组21例患者中完全再通13例,部分再通5例,症状性颅内出血3例,死亡1例,术后90d优者(BI≥90)12例,良者(50≤BI<90)6例,差者(BI<50)1例,术后6个月生活状态优者15例,良者3例,差者1例。两组14d、90d的NIHSS评分,相比有统计学意义。结论动脉溶栓能够明显提高闭塞血管再通率,改善患者急性期临床症状和远期预后。     

重组组织型纤溶酶原激活剂动静脉联合溶栓治疗急性缺血性卒中

目的 探讨使用重组组织型纤溶酶原激活剂(rt-PA)动静脉联合溶栓治疗急性缺血性卒中的临床疗效及安全性.方法 回顾性分析104例发病在6h内急性缺血性卒中患者的临床表现、治疗方法及疗效.其中超选择性动脉溶栓 静脉溶栓组(联合组)59例,同时超选择性动脉溶栓组(动脉组)45例.动脉组用微导管超选择至病变动脉,输注rt-PA50mg;联合组先静脉输注rt-PA,再经病变动脉输注rt-PA,总量＜50mg,在溶栓前和溶栓后6h、24h、7d、30d时,采用欧洲卒中量表(ESS)评价神经功能缺损情况.结果 治疗前ESS评分,联合组为41±3,动脉组为42±10,治疗后24h、30d时,ESS评分联合组为81±23、88±25;动脉组为75±27、80±23.治疗后总再通率联合组为53%(31/59),动脉组为33%(15/45),2组比较差异有统计学意义(P＜0.05).颅内出血的发生率联合组为7%(4/59),动脉组为9%(4/45),2组比较差异无统计学意义.结论 脑梗死患者起病6h内,动静脉联合溶栓是相对安全、有效的治疗方法.     

选择性动脉溶栓治疗急性脑梗死87例临床分析

目的探讨急性缺血性脑血管病选择性动脉溶栓治疗的适应证,以期提高动脉溶栓疗效,减少死亡率。方法87例急性缺血性脑血管病患者行选择性动脉溶栓治疗,ICA系统49例,发病多在6h内;VBA系统38例,发病多在12h以内。血管再通程度根据"急性心肌梗死溶栓标准"(TIMI)分类。临床结果评价在溶栓后30d进行,根据改良的Rank(MRS)评分,0～3分为好结果、4～6分为差结果。结果DSA造影结果,ICA完全闭塞20例,MCA的M1或M2段闭塞16例;溶栓后24例再通,12例未通。椎-基底动脉(VBA)系统,完全闭塞24例,溶栓后11例再通,13例未通。严重狭窄7例,溶栓后狭窄未见明显缓解。20例未见明显闭塞,结合临床症状及CT或MR检查考虑大脑中动脉或基底动脉深穿支闭塞。欧洲卒中评分(ESS):术前37.5±8.1,术后24h 50.6±11.6,术后2周58.2±12.4。痊愈35例(40.2%)、显效18例(20.7%)、有效11例(12.6%),未愈及死亡23例(26.5%)。发病2周以内死亡20例(ICA 3例,VBA 17例),脑出血和上消化道出血各死亡1例外,其余均死于脑梗死。溶栓术后30d,ICA系统30例(61.2%)患者为好结果(MRS 0～3),19例(38.8%)为差结果(MRS 4～6),其中4例(8.2%)死亡。V-BA系统12例(31.6%)患者为好结果(MRS 0～3),26例(68.4%)为差结果(MRS 4～6),其中19例(50%)死亡。结论急性期动脉溶栓治疗是安全有效的;术后24h的恢复程度与远期预后直接相关;动脉严重狭窄所致低灌注性脑梗死溶栓效果不佳;患者死亡的最主要原因是脑梗死及其并发症,极少数死于脑出血和消化道出血。     

急诊MRI快速评价对静脉溶栓治疗超急性期缺血性脑卒中的指导作用

目的探讨急诊MRI快速评价对静脉溶栓治疗超急性期缺血性脑卒中的指导价值。方法对224例发病不足12h的急性脑梗死患者予以CT平扫或MR颅脑快速成像序列扫描,其中91例超急性期缺血性脑卒中患者予以静脉溶栓治疗。对比治疗前后美国国立卫生院神经功能缺损评分(NIHSS)、Barthel指数(BI评分)、改良Rankin评分(mRS评分)变化,随访3个月,记录其并发症发生率及病死率。结果末次随访时,91例患者NIHSS评分及mRS评分均较治疗前显著降低,且BI评分较治疗前显著增高,差异有统计学意义(P0.05);在为期3个月的随访中,91例患者中仅1例(1.1%)因症状性颅内出血并发脑疝死亡,非症状性颅内出血9例(9.9%),症状性颅内出血3例(3.3%)。结论对经急诊MRI快速评价指导超急性期缺血性脑卒中患者予以静脉溶栓治疗的效果确切,可有效促进其神经功能恢复,对全面提升预后质量、改善其生活自理能力等具有积极影响,值得临床推广。     

急性缺血性脑卒中神经功能缺损对ADL的影响6个月随访研究

目的 探讨急性缺血性脑卒中神经功能缺损对日常生活能力（ADL）的影响.方法 以19岁～80岁的急性缺血性脑卒中患者为研究对象,斯堪的纳维亚脑卒中量表（SSS）评估神经功能,发病3个月及6个月时评定ADL（BI）.结果 缺血性卒中后3个月ADL依赖率为19%;6个月时15%,SSS与ADL呈正相关（P＜0.01）,ADL依赖患者的入院SSS评分低于非依赖者（P＜0.01）.Logistic回归分析发现：SSS是ADL独立影响因素.结论 缺血性脑卒中急性期神经功能缺损是患者ADL的独立影响因素.     

Temporal sustainability of guideline based door-to-needle times for intravenous thrombolysis for acute ischemic stroke

BackgroundDoor to needle (DTN) time provides valuable insight into stroke care workflow and is a performance indicator of an acute stroke unit. The aim of the current study was to ascertain whether a door to needle time of less than 60 min can be achieved for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and maintained long term in a comprehensive stroke unit.MethodsPatients with AIS treated with IVT in the stroke unit formed the study group. Demographic and clinical characteristics including door to imaging (DTI) time, DTN time, and 3 month functional outcome were abstracted. Pairwise comparison was done of yearly median DTI and DTN times with Bonferroni correction.ResultsOver a period of 6 years a total of 196 patients with mean age of 61.5 ± 13.1 years and median (IQR) NIHSS 11 (8–16) underwent IVT. The median DTI time and DTN time over the study period was 15 (12–21) minutes and 40 (30–50) minutes respectively. A total of 90.1%, 69.4% and 29.1% patients received IVT within 60 min, 45 min and 30 min respectively. On pairwise comparison of the median yearly DTN Year 2016 and 2017 were lower compared to most of the earlier years (p < 0.0001). Good functional outcome (mRS ≤ 2) was noted in 68.7% patients at 3 months follow-up.ConclusionIt is possible to sustainably reduce DTN time for IVT in AIS to well below the current 60 min benchmark with hospital system training and teamwork.     

Hyperacute thrombolysis with recombinant tissue plasminogen activator of acute ischemic stroke: Feasibility and effectivity from an Indian perspective

Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries like India, especially in areas such as western Utter Pradesh, where it is overly crowded and there is poor affordability.

Aim:

This study was done to evaluate recombinant tissue plasminogen activator r-tpa in acute ischemic stroke in hyper acute phase, in selected patients of western Utter Pradesh, in terms of feasibility and effectivity.

Design:

Open, non randomized study.

Materials and Methods:

Thirty two patients were classified using Trial of ORG 10172 in Acute Stroke treatment (TOAST) criteria (large artery atherosclerotic = 8; cardio embolic = 6; small vessel occlusion = 14; other determined etiology = 2; undetermined etiology = 2). The mean time to reach the hospital was 2 h (1.15-3.0), the mean door to CT scan 20 min (10-40) and door to r-tpa injection was 30 min (24-68). The National Institute of Health Stroke Scale (NIHSS) scores ranged from 11-22 (mean 15.5 +2.7). The dose of r-tpa administered was 0.9 mg/kg.

Results:

Twenty one patients (65.6%) showed significant improvement on the NIHSS score, at 48 h (4 points). (Mean change = 10; range = 4-17). At one month, 25 (78%) recorded improvement on the Barthel index (mean change = 45%). One developed frontal lobe hemorrhage and another developed recurrent stroke; one died of aspiration; and four showed no improvement. Modified Rankin score (m RS) was administered at the end of three months to 28 patients (90%); however, the rest could not be directly observed. The average modified Rankin Score was 1.2 (0-2).

Conclusions:

Hyperacute thrombolysis was found feasible and effective in selected patients with AIS from western Utter Pradesh and who had poor affordability.     

急性缺血性卒中患者发生院内消化道出血的危险因素分析

目的 分析急性缺血性卒中患者（acute ischemic stroke，AIS）住院期间消化道出血（gastrointestinal bleeding，GIB）的发生率、发生时间及危险因素。 方法 本研究纳入首都医科大学附属北京天坛医院急性卒中院内并发症队列（inhospital medical complication after acute stroke，iMCAS）研究中AIS患者。收集患者临床信息，根据住院期间是否发生 GIB分为GIB组和无GIB组，采用多因素Logistic回归模型，分析AIS患者发生GIB相关危险因素。 结果 共纳入1129例AIS患者，平均年龄58.7±12.5岁，女性230例（20.4%）。47例住院期间发生GIB， 发生率为4.2%，卒中发作至GIB确诊时间为5（3～13）d。合并肝硬化（OR 10.06，95%CI 2.44～41.38）、 高入院NIHSS评分（OR 1.13，95%CI 1.08～1.19）、高白细胞计数（OR 1.25，95%CI 1.13～1.38）、住院时 间长（OR 1.05，95%CI 1.01～1.10）是AIS患者发生消化道出血的独立危险因素。 结论 本单中心研究数据提示合并肝硬化、高入院NI HSS评分、高白细胞计数、住院时间长是AI S患 者住院期间发生GIB的独立危险因素。     

Cerebral vasomotor reactivity and dementia after ischemic stroke

Gur AY, Gücüyener D, Korczyn AD, Üzüner N, Gilutz Y, Özdemir G, Bornstein NM. Cerebral vasomotor reactivity and dementia after ischemic stroke.
Acta Neurol Scand: 2010: 122: 383–388.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objectives – Cerebral hemodynamic features of patients with post‐stroke dementia (PSD) are still obscure. We compared cerebral vasomotor reactivity (VMR) assessed in the acute phase of ischemic stroke (IS) in patients with and without PSD. VMR was also assessed and compared in demented and non‐demented patients in the late phase of IS. Materials and methods – VMR was assessed by transcranial Doppler and the Diamox test (1 g acetazolamide i.v.). PSD was confirmed by the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I’Enseignement en Neurosciences (NINDS‐AIREN) and the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria. VMR% values were compared to verify correlation with dementia. Results – Thirty patients with acute IS (AIS) were studied and followed for 3–6 months. An additional group of 37 patients was studied in the late post‐stroke period (PIS). VMR% values in the AIS groups with and without PSD were similar (25.3 ± 20.3% and 36.5 ± 22.4%, respectively, NS). The mean VMR% in the PIS groups with and without PSD were similar (32.3 ± 19.5% and 41.2 ± 24.8%, respectively, NS). Conclusions – VMR cannot predict the development of dementia after AIS and cannot identify patients with dementia in the late phase of stroke.     

Serum CXCL12 levels are associated with stroke severity and lesion volumes in stroke patients

Abstract

Objective:

Previous studies had shown that CXC chemokine ligand-12 (CXCL12) might play a significant role in stroke. The aim of this study was to test the serum baseline CXCL12 levels in Chinese patients with acute ischemic stroke (AIS).

Methods:

All consecutive patients with first-ever AIS from January 2013 to June 2014 were recruited to participate in the study. CXCL12 and National Institutes of Health Stroke Scale were measured at the time of admission. Logistic regression analysis was used to evaluate the risk of stroke according to serum CXCL12 levels. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy of serum CXCL12 in diagnosing stroke.

Results:

From 306 screened patients, a total of 239 patients with first-ever AIS were included in this study. The results indicated that the serum CXCL12 levels were significantly higher in AIS patients as compared to normal controls (P?<?0.0001). Serum CXCL12 were positively correlated with infarct volume(r?=?0.307, P?<?0.0001) and stroke severity(r?=?0.288, P?<?0.0001). After adjusting for all other possible covariates, CXCL12 was a stroke predictor with an adjusted OR of 2.047 [95% confidence interval (CI), 1.781–2.352; P?<?0.0001]. Based on the ROC curve, the optimal cutoff value of serum CXCL12 levels as an indicator for auxiliary diagnosis of AIS was projected to be 3.4?ng/ml, which yielded a sensitivity of 87.9% and a specificity of 72.0%, with the area under the curve at 0.902 (95% CI, 0.875–0.929).

Conclusion:

Our study demonstrated that serum CXCL12 levels increased significantly following AIS, and these changes in serum CXCL12 were positively correlated with infarct volume and stroke severity in Chinese sample.     

Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke

Objective

Dehydration may impair cerebral oxygen delivery and worsen clinical outcome in patients with acute ischemic stroke (AIS). We evaluated if elevated blood urea nitrogen to creatinine ratio (BUN/Cr) as a marker of dehydration was associated with poor clinical outcome in emergency department (ED) patients presenting with AIS.

Methods

We conducted a prospective cohort study using a stroke registry enrolling all ED patients with AIS from 10/2007 through 6/2009. Poor clinical outcome was defined as death, placement in a nursing home for purposes other than rehabilitation, or hospice within 30 days of ED presentation. A BUN/Cr ratio of ≥15 was considered elevated. (IQR). Logistic regression was performed adjusted for age >64 years, NIHSS >8, diabetes, prior CVA, and coma at presentation reporting odds ratios with 95% confidence intervals.

Results

324 patients had a final diagnosis of AIS. 163 (50%) were female, 19 (6%) died, 44 (14%) received t-PA, and 89 (27%) had a poor clinical outcome. The median NIHSS, BUN and Cr were 4 (IQR 1–9), 14 mg/dL (IQR 11–21), and 1.02 mg/dL (IQR 0.87–1.27) respectively. The median BUN/Cr was 13.9 (IQR 10.6–18.5). The variables associated with a poor clinical outcome were: high NIHSS OR 6.5 (3.6–11.8), age >64 years OR 2.7 (1.5–5.0), and BUN/Cr ratio of ≥15 OR 2.2 (1.2–4.0).

Conclusion

An elevated BUN/Cr ratio in patients with AIS is associated with poor outcome at 30 days. Further study is needed to see if acutely addressing hydration status in ED patients with AIS can alter outcome.     

尿激酶静脉溶栓治疗急性缺血性卒中/短暂性脑缺血发作的院内死亡率及相关影响因素的多中心分析

目的 探讨尿激酶静脉溶栓治疗急性缺血性卒中/TIA患者的院内死亡率及其影响因素。 方法 回顾性分析2013年1月-2016年5月河南省11家市级、县级医院神经内科连续收治的发病6 h内 接受尿激酶静脉溶栓治疗的急性缺血性卒中和TIA患者的临床资料，统计院内全因死亡率，采用多因 素Logistic回归分析院内死亡的相关影响因素。 结果 共入组444例患者，平均年龄60.19±11.61岁，男性296例（66.7%），院内死亡25例（5.6%）。多 因素Logistic回归分析显示，发病至溶栓时间3～6 h（OR 3.006，95%CI 1.120～8.071，P =0.029）、溶栓前 NI HSS评分（OR 1.130，95%CI 1.079～1.183，P＜0.001）及心房颤动病史（OR 3.671，95%CI 1.282～10.511， P =0.015）是尿激酶静脉溶栓治疗急性缺血性卒中/TIA患者院内死亡的独立影响因素。 结论 发病至溶栓时间3～6 h、严重神经功能损害、心房颤动病史是尿激酶静脉溶栓治疗急性缺 血性卒中/TIA患者住院期间死亡的独立危险因素。     

醒后卒中患者的凝血特征分析

目的 探讨醒后卒中（wake-up stroke,WUS）与非WUS患者凝血功能的差异,以探索WUS的病理生理学机制。 方法 回顾性收集2018年1月-2020年5月就诊于西安交通大学第二附属医院,发病72?h内的首次急性缺血性卒中（acute ischemic stroke,AIS）患者的临床资料,以同期非卒中入院、既往无卒中病史且性别、年龄（±5岁）匹配的患者为对照组。根据是否为WUS将AIS组分为WUS组和非WUS组。收集入组患者入院第2日的凝血功能检测结果。比较AIS组和对照组以及WUS组和非WUS组间的凝血功能差异。在AIS患者中,进一步采用二元logistic回归分析判断凝血功能与WUS的相关性。 结果 AIS组和对照组各342例,AIS患者中WUS 67例（19.6%）,非WUS 275例（80.4%）。单因素分析显示,与对照组比较,AIS组的活化部分凝血活酶时间（activated partial thromboplastin time,APTT）[23.2（20.7～26.3）s?vs.?24.0（21.6～26.8）s,P=0.019）和凝血酶时间[18.4（17.9～19.1）s?vs.?18.9（18.3～19.4）s,P＜0.001]缩短,而D-二聚体[270.0（170.0～460.0）ng/mL?vs.?220.0（137.5～352.5）ng/mL,P＜0.001]、纤维蛋白原[287.0（243.8～331.0）g/L?vs.?255.0（221.0～292.3）g/L,P＜0.001]及纤维蛋白降解产物[1.1（0.6～1.6）μg/mL?vs.?0.7（0.4～1.1）μg/mL,P＜0.001]水平升高。在AIS患者中,WUS组较非WUS组的入院时神经功能缺损更严重[NIHSS 3（2～6）分?vs.?2（1～4）分,P=0.005]、采血前使用他汀类药物的比例更高（94.0%?vs.?84.0%,P=0.034）,2组的发病到采血时间分布的差异也有统计学意义（P=0.011）。凝血功能方面,WUS组的APTT较非WUS组延长[24.8（21.5～27.5）s?vs.?22.9（20.5～25.9）s,P=0.004],其余凝血功能参数的差异无统计学意义。二元logistic回归分析显示,APTT延长与WUS独立相关（OR?2.082,95%CI?1.156～3.751,P=0.015）。 结论 WUS患者的APTT较非WUS患者延长,提示WUS患者可能具有更差的内源性凝血活性。