卒中患者脑微出血的MRI特点及其临床意义

目的 探讨卒中患者脑微出血（CMBs）的MRI特点及其临床意义，并比较MRI不同扫描序列检出CMBs的能力。方法 卒中患者60例，分为脑缺血组（34例）和脑出血组（26例），以同期查体的60岁以上健康老年人为对照组（30例）。采用常规MRI（包括SE T1WI和FSE T2WI）、扩散加权成像（DWI）、梯度回波T2加权成像（GRE-T2WI）和平面回波成像（EPI）检查，分别统计各组CMBs、腔隙性梗死、脑白质稀疏情况，同时记录卒中患者的高血压、糖尿病、卒中病史，比较不同扫描序列检出CMBs的差异。结果 CMBs在缺血组、出血组和对照组的发生率分别为29．4％，61．5％和6．7％。CMBs最常见于基底节／丘脑区。CMBs与高血压、卒中病史相关（P〈0．01），而与糖尿病无关（P〉0．05）。CMBs的数目与腔隙性脑梗死的数目和脑白质的改变程度成正相关（P〈0．01）。常规MRI和DWI均不能显示CMBs，EPI与GRE-T2WI检出CMBs的差异无统计学意义（P〉0．05）。结论 脑卒中患者多发性CMBs的存在提示微血管病变的严重程度和出血倾向，对于临床治疗决策具有重要的指导意义。GRE-T2WI是检测CMBs的首选方法，EPI可作为GRE-T2WI的补充手段。     

Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban

PurposeTo investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective.Materials and MethodsConsecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups—a thrombolytic with tirofiban group and a tirofiban-alone group—on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups.ResultsOf 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05).ConclusionsTirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.     

Evaluating the use of gradient echo imaging for the detection of cerebral microbleeds in acute stroke cases: A retrospective data analysis in a UK stroke unit

IntroductionImaging in stroke, allows its classification into ischaemic stroke (IS) or intracranial haemorrhagic stroke (ICH), ensuring time-sensitive treatment to be administered. Imaging can also allow detection of cerebral microbleeds (CMBs), which may further determine pharmacological intervention in acute stroke. True gradient echo (T21GRE) or susceptibility weighted imaging (SWI) have high sensitivity for the detection of CMBs. These two sequences are included in the national guidelines; however, the implementation of these guidelines can vary depending on local interpretation and scanner capabilities.AimTo explore the use and application of blood sensitive MRI sequences in a specialist UK stroke unit for the detection of CMBs, to improve local practice.MethodsA retrospective data analysis of the native database, spanning a 6-month period, was used. The data of 281 acute stroke patients with an MRI were reviewed and analysed. The MRI sequences applied, and the final diagnosis were noted for each case.ResultsOf the 281 acute stroke patients with MRI, 259 (92.1%) had an IS, 16 (5.68%) an ICH and 6 (2.14%) had both. Overall, 13 (4.63%) had a CMB diagnosis. All of these 13 patients had a true T21GRE sequence. CMBs were not detected in the absence of a T21GRE sequence.ConclusionT21GRE imaging is essential for detecting CMBs. When omitted, CMB incidence can be considerably lower than that suggested in the literature. Missing CMB diagnoses in stroke patients may result in suboptimal treatment pathways, compromising the patients' standard of care.Implications for practiceWhen SWI is not available, it is imperative to always include a true T21GRE sequence to detect microbleeds in suspected acute stroke cases.     

多模式MRI指导的超急性期缺血性脑卒中静脉溶栓治疗

2008

磁共振多模式快速成像指导缺血性脑卒中溶栓八例 [其它论文] -中华神经科杂志2008

2.0.TX;2-J.aspx'>Treatment of acute ischemic stroke [其它论文] 2000

Extending the time window for thrombolysis:evidence from acute stroke trials 2005

The evolving role of acute stroke imaging in intravenous thrombolytic therapy:patient selection and outcomes assessment 2005

Schellinger PD.Thomalla G.Fiehler J MRI-basod and CTbased thrombolytic therapy in acute stroke within and beyond established time windows:an analysis of 1210 patients [其它论文] 2007

卫生部疾病控制司.中华医学会神经科学会 中国脑血管病防治指南 2005

Thomalla G.Schwark C.Sobesky J Outeome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients:comparison of a german multicenter study with the pooled data of ATLANTIS,ECASS and NINDS rt-PA trials [其它论文] 2006

Warach S.Dashe JF.Edelman RR Clinical outcome in iachemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging:a preliminary analysis 1996

Barber PA.Darby DG.Desmond PM Prediction of stroke outcome with echoplanar perfusion-and diffusion-weighted MRL 1998

薛静.高培毅.林燕 MR血管成像在急性缺血性脑卒中溶栓治疗中的价值 [其它论文] -中华放射学杂志2008

Donnan GA.Howells DW.Markus R Can the time window for administration of thrombolyties in stroke be increased? 2003

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Imaging in acute stroke

Stroke is a syndrome characterized by a sudden neurological deficit caused by intracranial hemorrhage or ischemia. Computed tomography (CT) maintains a primary role in the evaluation of patients with acute stroke. The optimal magnetic resonance imaging (MRI) protocol in acute stroke includes diffusion-weighted imaging (DWI) to show acute ischemic lesion and MR perfusion study to estimate brain perfusion. Careful selection of patients for a thrombolytic therapy is crucial to improve safety and efficacy.     

SWI在脑微出血与急性期脑梗死后出血转化的相关性研究

目的探讨急性脑梗死脑出血转化(HT)与微出血(CMBs)的相关性。方法回顾性分析发病在24 h内经临床及扩散加权成像(DWI)确诊的急性期脑梗死患者资料72例,根据磁敏感加权成像(SWI)图像梗死灶内是否出现极低信号分为梗死后出血转化组(HT组)和单纯脑梗死组(对照组)。同时对病灶以外CMBs经两名影像学医师诊断记为CMBs阳性共32例,其中对照组24例(24/62,38.7%),HT组8例(8/10,80%)。根据CMBs分布分为脑叶组和脑深部组,对照组脑叶8例(8/24,33.33%),脑深部16例(16/24,66.67%)。HT组脑叶7例(7/8,87.5%),脑深部1例(1/8,12.5%)。结果两组CMBs检出率及发生部位差异均有统计学意义(P值<0.05)。结论梗死后HT与CMBs的发生率和发生部位相关,SWI可检出CMBs,预示微血管的出血倾向,预测急性期脑梗死HT的危险性,进而为溶栓治疗提供可能的依据。     

Diffusion and perfusion MR imaging in stroke

Magnetic resonance imaging (MRI) in stroke makes it possible to visualize the initial infarct in cases of acute cerebral ischemia. Perfusion MRI serves to determine which tissues are additionally at risk of infarction due to persistent hypoperfusion. MRI also allows those examiners with limited experience to reliably confirm an infarct. The most important differential diagnosis of cerebral ischemia, intracerebral hemorrhage, can likewise be recognized with certainty using MRI. Although diffusion and perfusion MRI only demonstrate the pathophysiology of cerebral ischemia approximately, the method is suited for identifying those patients who would profit from reperfusion therapy. Whether MRI is also appropriate as an aid to reaching a prognosis on the risk of secondary hemorrhage has not yet been resolved.     

弥散加权MRI评价经动脉溶栓治疗急性脑梗塞实验研究

目的用弥散加权(diffusion-weightedDW)MRI技术评价经动脉溶栓治疗急性脑梗塞的效果。材料和方法新西兰白兔20只,随机分为2组,每组10只,颈内动脉注入血凝块栓子制成急性脑梗塞动物模型。实验组在栓塞后4h经动脉给予尿激酶溶栓治疗。分别在栓塞后1,3,6,12,24h行DW-MRI系列扫描。测量并以1h为基准计算缺血面积在各时间点的扩大程度(百分比)。结果栓塞后1hDW-MRI均可显示梗塞灶;与1h点相比,非治疗组缺血面积在栓塞后3,6,12,24h分别扩大了23.1％,25.6％,39.5％,43.4％,而治疗组分别扩大了19.5％,25.7％,20.6％,19.7％,两组间在12h后差异显著(P<0.01)。结论早期经动脉溶栓治疗在减轻急性脑梗塞损伤范围和程度上效果显著;DW-MRI是诊断和监测急性脑梗塞治疗效果的很好影像学手段。     

Combinations of the presence or absence of cerebral microbleeds and advanced white matter hyperintensity as predictors of subsequent stroke types

BACKGROUND AND PURPOSE: Previous studies have shown microbleeds to be a risk factor for intracerebral hemorrhage and white matter hyperintensity (WMH) to be a risk factor for ischemic stroke. This study was performed to determine whether combinations of the presence or absence of microbleeds and advanced WMH are risk factors for subsequent recurrent stroke types. METHODS: In 266 patients with stroke, microbleeds on T2*-weighted MR images were counted, and WMH on T2-weighted images was graded. Patients were divided into 4 groups by the combinations of the presence or absence of microbleeds and advanced WMH and were followed up for stroke recurrence. RESULTS: During a mean follow-up period of 564.8 +/- 220.5 days, 26 patients developed recurrent strokes, including 10 intracerebral hemorrhages and 16 ischemic strokes. Patients with microbleeds without advanced WMH (n = 42) developed only intracerebral hemorrhages (n = 8), and the recurrence rate of intracerebral hemorrhage in those patients estimated by the Kaplan-Meier method was the highest in the 4 groups (14.3% in 1 year and 21.2% in 2 years). In contrast, patients with advanced WMH without microbleeds (n = 39) developed only ischemic strokes (n = 6), and the estimated recurrent rate of ischemic stroke in those patients was the highest in the 4 groups (10.5% in 1 year and 17.4% in 2 years). Cox proportional hazards regression analysis revealed that microbleeds were associated with intracerebral hemorrhage (hazard ratio [HR], 85.626; 95% confidence interval [CI], 6.344-1155.649) and that advanced WMH was negatively associated with intracerebral hemorrhage (HR, 0.016; 95% CI, 0.001-0.258). Advanced WMH was associated with ischemic stroke (HR, 10.659; 95% CI, 2.601-43.678). CONCLUSION: It appears that patients at high risk of subsequent intracerebral hemorrhage or ischemic stroke can be identified by combinations of the presence or absence of microbleeds and advanced WMH.     

利用SWI探讨急性脑梗死合并脑微出血静脉溶栓风险

目的：探讨急性脑梗死合并脑微出血(CMBs)的相关危险因素及静脉溶栓治疗后出血转化风险。方法收集164急性脑梗死患者,入院时均行常规 MRI 及 SWI 扫描,根据 SWI 上有无 CMBs 分为 CMBs 阳性组和 CMBs 阴性组,记录所有患者的一般临床资料,探讨 CMBs 的相关危险因素。静脉溶栓治疗后的76例患者,其中 CMBs 阳性组35例,CMBs 阴性组41例,分别计数2组患者 CMBs 数目增多或出现出血转化的例数。结果年龄、高血压病、腔隙性梗死、脑白质疏松与 CMBs 相关性显著(P <0.05)。静脉溶栓后2组患者间出血转化率差异无统计学意义(P >0.05)。结论性别、年龄、高血压病、腔隙性脑梗死、脑白质疏松是CMBs 的危险因素。急性脑梗死合并 CMBs 患者静脉溶栓治疗不会增加出血转化危险。     

MR pattern of hyperacute cerebral hemorrhage

Magnetic resonance (MR) pattern of cerebral hemorrhage relates mainly to the relaxation and susceptibility effects of iron-containing hemoglobin degradation products, as well as to their intra- or extracellular location. The purpose of this article is to report two acute stroke patients who underwent thrombolytic therapy and developed hyperacute cerebral hemorrhage during their admission cerebral MR survey. They constitute the earliest MR appearance of hyperacute intracerebral bleeding reported in the literature, featuring increased diffusion properties and persistent susceptibility effect on perfusion-weighted imaging (PWI)-series.     

MR of cerebral abnormalities concomitant with primary intracerebral hematomas.

PURPOSETo determine whether arteriolar vessel wall degeneration in primary intracerebral hematomas might be associated with ischemic brain lesions and clinically silent (apparently intracerebral) previous hemorrhages.METHODSThe MR images of 120 consecutive patients (mean age, 60 years; age range, 22 to 84 years) with their first stroke caused by a primary intracerebral hematoma were reviewed retrospectively for coexisting ischemic damage and previous bleeds.RESULTSEarly confluent to confluent white matter hyperintensities, lacunes, or infarction were present in 83 (69%) of the patients, and 39 (33%) had had previous hemorrhages consisting of microbleeds or old hematomas. Extensive white matter hyperintensities and lacunes were most frequent in patients with thalamic primary intracerebral hematomas. There was no relationship between the frequency of old hemorrhages and the location of subsequent primary intracerebral hematomas.CONCLUSIONClinically silent ischemic lesions and previous hemorrhages are a common finding on MR images of patients with primary intracerebral hematoma. They may therefore serve as evidence of diffuse microangiopathy with a possible increased risk for cerebral hemorrhage.     

Noncontrast conventional computed tomography in the evaluation of acute stroke

The advantages of CT scanning in the assessment of hyperacute stroke patients include convenience, accuracy, speed, and low cost. CT scanning is presently considered to be the standard of care for the detection of acute extra-axial and parenchymal hemorrhage, although newer MRI techniques are challenging this claim. The accuracy of CT scanning for stroke detection can be optimized by the use of appropriate scanning technique, as well as interactive image review at a picture archiving and communication system workstation using narrow window and level settings. More importantly, CT scanning has prognostic value for patients receiving thrombolytic treatment by helping to predict both responses to treatment and hemorrhage risk. Finally, as will be discussed in other articles in this issue, CT angiography can be performed in the same imaging session as noncontrast CT scanning without substantially increasing the time required for patient evaluation. This provides data regarding vascular patency and tissue perfusion, which are valuable in the triage of stroke patients.     

Acute stroke magnetic resonance imaging: current status and future perspective

Cerebral stroke is one of the most frequent causes of permanent disability or death in the western world and a major burden in healthcare system. The major portion is caused by acute ischemia due to cerebral artery occlusion by a clot. The minority of strokes is related to intracerebral hemorrhage or other sources. To limit the permanent disability in ischemic stroke patients resulting from irreversible infarction of ischemic brain tissue, major efforts were made in the last decade. To extend the time window for thrombolysis, which is the only approved therapy, several imaging parameters in computed tomography and magnetic resonance imaging (MRI) have been investigated. However, the current guidelines neglect the fact that the portion of potentially salvageable ischemic tissue (penumbra) is not dependent on the time window but the individual collateral blood flow. Within the last years, the differentiation of infarct core and penumbra with MRI using diffusion-weighted images (DWI) and perfusion imaging (PI) with parameter maps was established. Current trials transform these technical advances to a redefined patient selection based on physiological parameters determined by MRI. This review article presents the current status of MRI for acute stroke imaging. A special focus is the ischemic stroke. In dependence on the pathophysiology of cerebral ischemia, the basic principle and diagnostic value of different MRI sequences are illustrated. MRI techniques for imaging of the main differential diagnoses of ischemic stroke are mentioned. Moreover, perspectives of MRI for imaging-based acute stroke treatment as well as monitoring of restorative stroke therapy from recent trials are discussed.     

急性脑梗死溶栓治疗前后血清IL-6、TNF-α水平的变化

目的研究血清IL-6、TNF-α水平的变化对rt-PA溶栓治疗的临床意义。方法超早期脑梗死患者60例,根据家属是否同意溶栓分为rt-PA溶栓组（30例）和巴曲酶治疗组（30例）,比较两组治疗前及治疗后24h血清中IL-6、TNF-α水平,以及治疗前后NIHSS评分及Barthel指数情况。结果两治疗组IL-6、TNF-d水平较正常对照组明显升高。rt-PA组细胞因子下降程度及神经功能缺损改善程度更显著,且不增加出血率及死亡率。结论IL-6、TNF-α对判定急性脑梗死的病情程度、疗效及预后有重要意义;rt-PA溶栓治疗优于巴曲酶治疗;rt-PA溶栓治疗是相对安全有效的。     

急性脑梗死溶栓治疗前后血清IL-6、TNF-α水平的变化

目的研究血清IL-6、TNF-α水平的变化对rt-PA溶栓治疗的临床意义。方法超早期脑梗死患者60例,根据家属是否同意溶栓分为rt-PA溶栓组（30例）和巴曲酶治疗组（30例）,比较两组治疗前及治疗后24h血清中IL-6、TNF-α水平,以及治疗前后NIHSS评分及Barthel指数情况。结果两治疗组IL-6、TNF-α水平较正常对照组明显升高。rt-PA组细胞因子下降程度及神经功能缺损改善程度更显著,且不增加出血率及死亡率。结论IL-6、TNF-α对判定急性脑梗死的病情程度、疗效及预后有重要意义;rt-PA溶栓治疗优于巴曲酶治疗;rt-PA溶栓治疗是相对安全有效的。     

SWI对急性期脑梗死合并脑微出血的诊断价值及临床相关因素研究

目的:探讨SWI对急性期脑梗死合并脑微出血(cerebralmicrobleeds,CMBs)的诊断价值及急性期脑梗死合并CMBs的危险因素。方法:选取急性期脑梗死患者62例,采用GE Signa HDX 3.0T超导型MR仪,行常规MRI及DWI、SWI序列。并结合临床相关资料,研究分析:①SWI对急性期脑梗死患者CMBs的检出率和CMBs在SWI的分布特点;②结合患者性别,年龄及有无高血压、糖尿病、高脂血症、心脏病等6项临床相关因素,分析急性期脑梗死合并CMBs的危险因素。结果:MRI常规序列、DWI及SWI对62例急性期脑梗死合并CMBs的阳性检出率分别为:0.00%,8.06%,40.32%,差异具有统计学意义,SWI的阳性检出率高于常规MRI检查和DWI序列。CMBs在SWI分布特点:25例急性期脑梗死合并CMBs的CMBs灶均为多发病灶,在脑内各个区域分布不等,以基底节-丘脑区最多,其次为皮质-皮质下区,脑干和小脑最少。患者的年龄、高血压与急性期脑梗死合并CMBs有相关性(P<0.05),年龄(OR=1.704,95%CI 0.029～2.840,P<0.001)和高血压OR=1.039,95%CI 1.003～1.588,P=0.019)是急性期脑梗死合并CMBs的危险因素。糖尿病、高脂血症、心脏病等与急性期脑梗死合并CMBs无相关性(P>0.05)。结论:SWI对急性期脑梗死合并CMBs的检出比常规MRI和DWI有优势,是检出CMBs的较好检查技术。年龄、高血压是急性期脑梗死合并CMBs的独立危险因素。     

Flat Detector Angio-CT following Intra-Arterial Therapy of Acute Ischemic Stroke: Identification of Hemorrhage and Distinction from Contrast Accumulation due to Blood-Brain Barrier Disruption

BACKGROUND AND PURPOSE:Flat panel detector CT in the angiography suite may be valuable for the detection of intracranial hematomas; however, abnormal contrast enhancement frequently mimics hemorrhage. We aimed to assess the accuracy of flat panel detector CT in detecting/excluding intracranial bleeding after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption.MATERIALS AND METHODS:Seventy-three patients were included for retrospective evaluation following endovascular stroke therapy: 32 after stent-assisted thrombectomy, 14 after intra-arterial thrombolysis, and 27 after a combination of both. Flat panel CT images were assessed for image quality and the presence and type of intracranial hemorrhage and BBB disruption by 2 readers separately and in consensus. Follow-up by multisection head CT, serving as the reference standard, was evaluated by a single reader.RESULTS:Conventional head CT revealed intracranial hematomas in 12 patients (8 subarachnoid hemorrhages, 7 cases of intracerebral bleeding, 3 SAHs plus intracerebral bleeding). Image quality of flat panel detector CT was considered sufficient in all cases supratentorially and in 92% in the posterior fossa. Regarding detection or exclusion of intracranial hemorrhage, flat panel detector CT reached a sensitivity, specificity, positive and negative predictive values, and accuracy of 58%, 85%, 44%, 91%, and 81%, respectively. Maximum attenuation measurements were not valuable for the differentiation of hemorrhage and BBB disruption.CONCLUSIONS:Flat panel CT after endovascular stroke treatment was able to exclude the rare event of an intracranial hemorrhage with a high negative predictive value. Future studies should evaluate the predictive value of BBB disruptions in flat panel detector CT for the development of relevant hematomas.

Flat panel detectors in modern angiographic C-arm systems allow almost instant access to CT-like cranial imaging in the angiography suite.^1–4 While flat panel detector CT (FPCT) is currently not reliable in depicting ischemic brain lesions, it proved to be a sensitive tool for the detection of intracranial hematomas in both experimental and clinical settings.^5,6 However, there have been numerous reports of abnormal contrast enhancement following neurovascular interventions that frequently mimic subarachnoid, intraventricular, or intracerebral hemorrhage.^7–9 It is important to recognize such patterns of temporary blood-brain barrier disruption in postprocedural imaging because misinterpretation may unnecessarily delay anticoagulant/antiaggregant treatment.In the present study, we aimed to assess the diagnostic accuracy of FPCT for the detection of intracranial bleeding immediately after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption.     

Hyperactivity of 99mTc-HMPAO within 6 hours in patients with acute ischemic stroke.

Intraarterial thrombolytic therapy has been used recently for treatment of acute ischemic stroke within 6 h after onset. Although hypoactivity of 99mTc-hexamethylpropyleneamine oxime (HMPAO) in stroke has been well documented, hyperactivity of HMPAO has not been evaluated in sufficient detail. The purpose of this study was to evaluate the incidence and clinical importance of hyperactivity of HMPAO in management of patients with acute ischemic stroke. METHODS: We retrospectively investigated HMPAO SPECT in 90 patients with acute ischemic stroke within 6 h after onset. The lesion-to-contralateral radioactivity ratios (L/Cs) were calculated on the SPECT images before treatment and were compared with the imaging results of CT or MRI (or both). RESULTS: Hyperactivity of HMPAO, accompanied by surrounding hypoactivity, was observed in 6 of 90 patients (7%) within 6 h after onset. The L/Cs ranged from 1.17 to 2.95. Two patients showed hyperactivity in the cortex and the other 4 patients showed hyperactivity in the basal ganglia. Angiography confirmed spontaneous recanalization of occluded vessels in accordance with the area of hyperactivity. In both patients with cortical hyperactivity, cerebral infarctions were revealed on follow-up CT; in 1 patient, hemorrhagic transformation developed after intraarterial thrombolytic therapy. In 3 of the 4 patients with hyperactivity in the basal ganglia, follow-up CT showed no infarction in the surrounding hypoperfused cortex (selective intraarterial thrombolytic therapy was performed on 2 patients), although various degrees of infarction were observed in the basal ganglia. Obvious infarctions developed in the basal ganglia and the cortex of the other patient. CONCLUSION: Hyperactivity of HMPAO could be seen in the basal ganglia and the cortex within 6 h after onset, reflecting spontaneous recanalization. The areas of hyperactivity may develop infarctions, whereas the accompanying areas of hypoactivity could be rescued by selective intraarterial thrombolytic therapy.     

Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years

BACKGROUND AND PURPOSE: Intra-arterial fibrinolytic therapy is a promising treatment for acute ischemic stroke. Few data are available on its use in elderly patients. The purpose of this study was to compare the baseline characteristics, complications, and outcomes between intra-arterially treated ischemic stroke patients aged > or = 80 years and their younger counterparts. METHODS: Patients aged > or = 80 years (n = 33) were compared retrospectively with contemporaneous patients aged < 80 years (n = 81) from a registry of consecutive patients treated with intra-arterial thrombolysis over a 9-year period. RESULTS: The very elderly and younger cohorts were very similar in baseline characteristics, including pretreatment stroke severity (National Institutes of Health Stroke Scale [NIHSS] 17 versus 16), differing only in history of stroke/transient ischemic attack (42% versus 22%, P = .01) and weight (66.8 versus 75.8 kg; P = .02). Significant differences in recanalization (TIMI 2-3) rates could not be detected between the very elderly and younger patients (79% versus 68%, P = .10). Rates of major symptomatic hemorrhage (7% versus 8%) and any intracerebral hemorrhage (39% versus 37%) did not differ. Outcomes at 90 days showed lower rates of excellent functional outcome (mRS < or = 1, 26% versus 40%, P = .02) and survival (57% versus 80%, P = .01) among the very elderly. CONCLUSIONS: Intra-arterial fibrinolysis in the elderly can be accomplished with recanalization rates and hemorrhage rates equal to that in younger patients. Although mortality rates are higher and good functional outcomes are lower than in younger persons, nondisabling outcomes may be achieved in a quarter of patients. These findings suggest that the investigation and use of intra-arterial thrombolytic treatment in very elderly patients should not be avoided but pursued judiciously.