基于磁共振动脉自旋标记技术指导的急性缺血性卒中静脉溶栓研究

目的 探讨磁共振成像（magnetic resonance imaging,MRI）动脉自旋标记技术（arterial spin label,ASL） 指导缺血性卒中静脉溶栓治疗的有效性和安全性,探索新的、高效的指导急性缺血性卒中静脉溶 栓的技术。 方法 入选发病至就诊时间大于3 h,在MRI-ASL指导下进行重组组织型纤溶酶原激活物（recombinant tissue plasminogen activator,rt-PA）静脉溶栓的急性缺血性卒中患者,同时选取在MRI灌注加权像 （perfusion-weighted imaging,PWI）指导下进行rt-PA静脉溶栓的急性缺血性卒中患者为对照组。比较两 组患者的基线资料、既往病史、入院至溶栓时间、影像学检查至溶栓时间、发病90 d的美国国立卫 生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分、预后良好[改良Rankin量表 （modified Rankin Scale,mRS）0～1分]率及出血转化发生率等。 结果 ASL组和PWI组相比,基线数据无显著差异;出血转化率也无显著差异。ASL组影像学检查至 溶栓时间短于PWI组（[ 65±15）min vs（73±11）mi n,P=0.031]。 结论 ASL较PWI技术指导急性缺血性卒中静脉溶栓可以减少延误时间,其安全性和有效性无差异。     

急性缺血性脑卒中发病6 h内MR-DWI阴性与阳性患者静脉溶栓的临床结局对比研究

目的 对比分析急性缺血性脑卒中(AIS)发病6 h内头颅磁共振(MR)弥散加权成像(DWI)显示为阴性及阳性的患者使用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的临床结局和安全性。方法 回顾性分析50例AIS患者住院治疗行rt-PA静脉溶栓，根据静脉溶栓前MR-DWI检查结果将AIS患者分为DWI阴性组18例和DWI阳性组32例，分析两组患者的人口学特征以及临床资料，包括入院至静脉溶栓时间(DNT)、发病至静脉溶栓时间(OTT)，溶栓结束24 h内复查DWI，以发病后90 d的NIHSS评分和改良Rankin量表(mRS)评分作为预后的评估指标。结果 两组患者年龄、性别、脑梗死病史、高血压病病史、糖尿病病史、房颤病史、吸烟史、饮酒史、DNT、OTT、颅内出血发生率和病死率比较差异均无统计学意义(均P>0.05)；两组患者静脉溶栓前mRS评分及NIHSS评分均高于溶栓后90 d mRS评分及NIHSS评分(均P<0.05),DWI阴性组90 d mRS评分及NIHSS评分低于DWI阳性组(P<0.001,P=0.001)。结论 发病6 h内DWI阴性及阳性的AIS患...     

阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者的预后相关因素分析

目的探讨分析影响阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者的预后的相关因素。方法选取发病0~4.5 h急性后循环缺血性卒中患者,分为阿替普酶静脉溶栓组和非静脉溶栓组,记录患者的一般人口学资料及基本资料、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,溶栓组记录发病至溶栓时间及溶栓后24 h NIHSS评分下降。结局指标采用90 d改良Rankin量表(modified Rankin Scale,m RS)评分、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)及患者死亡率,应用Logistic回归模型分析卒中患者90 d不良结局的相关因素。结果急性后循环缺血性卒中患者共116例,其中成功给予阿替普酶静脉溶栓治疗的患者84例,非静脉溶栓32例。静脉溶栓组3个月预后良好53例(63.1%),预后不良31例(36.9%),其中发生出血转化6例(7.1%),症状性颅内出血3例(3.5%),死亡3例(3.5%)。非静脉溶栓组3个月预后良好12例(37.5%),预后不良20例(62.5%),其中发生出血转化5例(15.6%),症状性颅内出血3例(9.3%),死亡3例(9.3%)。静脉溶栓组经多因素Logistic回归分析显示,年龄、发病至溶栓时间、基线NIHSS评分、高血压与90 d不良预后相关(P0.05)。静脉溶栓组和非静脉溶栓组相比,静脉溶栓组有更好的临床预后及更低的死亡率,两组在症状性颅内出血发病率方面并无明显差异。结论对于急性后循环缺血性卒中患者,尽早实施静脉溶栓对改善近期预后有一定临床意义。     

DWI阴性的急性缺血性卒中患者的临床特点和原因分析

目的探讨弥散加权成像(diffusion weighted imaging,DWI)阴性的急性缺血性卒中患者的临床特点、影像学表现、病因。方法回顾性分析自2012年1月~2014年7月首都医科大学附属北京天坛医院神经内科急诊溶栓绿色通道就诊的DWI阴性的疑似急性缺血性卒中患者,收集其人口学特征、临床表现、影像数据,进行病因学分类。结果连续收集134例溶栓医生初步判断为DWI阴性的疑似急性缺血性卒中患者,其中男性90例,女性44例,中位数年龄57岁(四分位数间距50~70),从发病到完成DWI检查的中位数时间266.5 min(四分位数间距205.3~362.5)。中位数美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分2(四分位数间距1~3)。33例患者住院进一步诊治。有27例(81.8%)被诊断为缺血性卒中,另有6例(18.2%)诊断为其他疾病。27例诊断为缺血性卒中的住院患者中,9例(33.3%)经重新读片后发现缺血灶,5例(18.5%)症状加重后复查出现缺血灶,1例(3.7%)未加重但复查出现缺血灶,1例(3.7%)症状加重后复查DWI仍无缺血灶但有可以解释症状的磁共振血管成像(magnetic resonance angiography,MRA)大血管闭塞/狭窄或灌注加权成像(perfusion weighted imaging)低灌注区,6例(22.2%)虽DWI阴性但MRA有可以解释症状的大血管闭塞/狭窄或PWI有低灌注区,5例(18.5%)DWI阴性且未见大血管异常。诊断为缺血性卒中的27例患者,根据急性卒中治疗低分子肝素试验病因分型法(Trial of Org 10172 in Acute Stroke Treatment,TOAST)的分型标准,15例(55.6%)为大动脉粥样硬化,11例(40.7%)为小动脉闭塞,1例(3.7%)病因不明。住院患者中,除1例(3.0%)患者出院时明显残疾外,其余32例(97.0%)患者出院时结局良好。101例患者在急诊治疗后出院。其中80例(79.2%)DWI阴性且未见其他异常,5例(5.0%)经重新读片后发现缺血灶,14例(13.9%)虽DWI阴性但MRA有可以解释症状的大血管闭塞/狭窄或PWI低灌注区修正诊断为缺血性卒中,2例(2.0%)诊断为其他疾病。结论 DWI阴性的急性缺血性卒中,多数为小卒中。大动脉粥样硬化性闭塞/狭窄和小动脉闭塞是主要病因。在急诊溶栓绿色通道中,溶栓医生初步判断为DWI阴性的疑似急性缺血性卒中患者,存在读片遗漏、显影延迟的可能和病情加重的风险。     

动静脉联合血管再通治疗急性脑卒中的疗效和安全性分析

目的观察在急性缺血性脑卒中患者中应用动静脉联合血管再通治疗的疗效和安全性。方法对2011年11月至2014年12月收治的急性缺血性脑卒中[美国国立卫生研究院卒中量表(NIHSS)评分≥10分]83例患者进行回顾性分析。将单纯静脉溶栓治疗的62例患者归为溶栓组;将静脉溶栓后无好转再行动脉内支架取栓治疗的21例患者归为取栓组。对两组进行疗效和安全性比较:1治疗7 d时比较两组NIHSS及改良Rankin(m RS)评分;2比较治疗后24 h的出血转化率和治疗后7 d的病死率。结果溶栓组和取栓组基线特征除高血压病史外余均差异无统计学意义(P﹥0.05)。两组疗效比较,治疗后7 d,NIHSS评分和m RS评分均差异无统计学意义(P﹥0.05)。两组安全性比较,治疗后24 h头颅CT显示出血转化率差异无统计学意义(P﹥0.05),两组治疗后7 d的病死率差异无统计学意义(P﹥0.05)。结论动脉取栓治疗的安全性与静脉溶栓治疗比较差异无显著性,且疗效未见比静脉溶栓治疗更好,可能与取栓治疗时间存在延误有关。     

高龄急性轻型缺血性卒中早期阿替普酶静脉溶栓疗效观察

目的 探讨高龄轻型缺血性卒中3 h内行阿替普酶静脉溶栓治疗的疗效及安全性。 方法 将我院2015年10月-2017年10月连续收治入院的发病3 h内48例高龄急性轻型缺血性卒中患者 随机分为阿替普酶静脉溶栓组24例和未溶栓组24例。比较两组患者入院时的一般情况,基线美国 国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NHISS）评分,治疗24 h后颅内出 血转化率,治疗后90 d改良Rankin量表（modified Rankin Scale,mRS）评分及90 d病死率。 结果 阿替普酶静脉溶栓组和未溶栓组患者一般临床资料、基线NIHSS评分比较,差异无统计学意 义。阿替普酶静脉溶栓组和未溶栓组治疗24 h后颅内出血转化率分别为4.17%和0（P =1.000）,两组 90 d病死率均为4.17%（P =1.000）,阿替普酶静脉溶栓组及未溶栓组90 d mRS评分为0～2分的比率 分别为83.33%和54.17%（P =0.029）。 结论 早期阿替普酶静脉溶栓治疗高龄急性轻型缺血性卒中不增加急性期颅内出血转化的风险, 可以改善高龄轻型缺血性卒中患者预后,不增加病死率。     

早期静脉溶栓治疗急性轻型缺血性卒中的疗效观察

目的探讨早期静脉溶栓治疗急性轻型缺血性卒中的疗效及安全性。方法将70例首次急性轻型缺血性脑卒中患者随机分为溶栓组(35例)及未溶栓组(35例)。溶栓组于入院后给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,未溶栓组给予阿司匹林(100 mg/d)口服。于出院时采用NIHSS评分评价患者神经功能缺损情况,治疗3个月后采用mRS评价患者预后。结果入院时溶栓组及未溶栓组患者一般临床资料差异无统计学意义(均P0.05)。与未溶栓组患者比较,溶栓组患者出院时NIHSS评分显著降低,预后良好的比率显著增高(P0.05~0.01)。两组患者均未发生症状性脑出血及死亡。结论静脉溶栓治疗可以显著改善轻型缺血性卒中患者的预后,并且不会增加其颅内出血的风险。     

静脉溶栓联合双重抗血小板药物在MIS或TIA患者中的疗效分析

目的探析静脉溶栓联合双重抗血小板药物在轻型缺血性卒中(MIS)或短暂性脑缺血发作(TIA)患者中的临床疗效。方法分析2015年4月至2016年8月在承德市中心医院接受治疗的98例MIS及TIA患者的临床资料。随机将入选者分成A组(传统静脉溶栓组,32例)、B组(联合静脉溶栓组,33例)和C组(未溶栓组,33例)3组。比较3组患者的一般资料、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)评分、改良Rankin量表(m RS)评分及治疗后症状性脑出血率、死亡率及复发率。结果 3组患者的一般资料及治疗前的NIHSS评分、BI评分及m RS评分差异无统计学意义(P0.05);治疗后,B组患者的NIHSS评分及m RS评分明显高于A、C组,BI评分明显低于A、C组(P0.05)。治疗后3组患者均未出现症状性脑出血及死亡病例;C组患者复发率明显高于A、B组(P0.05)。结论静脉溶栓联合双重抗血小板治疗MIS或TIA患者的临床疗效显著,安全性良好,值得推广。     

早期神经功能改善对缺血性卒中患者静脉溶栓预后的预测作用

目的探究缺血性卒中患者静脉溶栓后基于美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分的早期神经功能改善(early neurologic improvement,ENI)对患者3个月结局的预测作用。方法本研究的入选患者来自中国急性缺血性卒中溶栓监测登记研究(Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China,TIMS-China),从中选取所有进行溶栓前NIHSS评分、溶栓后2 h和24 h NIHSS评分的患者,将ENI定义为溶栓后2 h NIHSS评分减少≥5分或NIHSS评分等于0分,以及溶栓后24 h NIHSS评分减少≥8分或NIHSS评分等于0分,结局指标包括溶栓后90 d的改良Rankin量表(modified Rankin Scale,m RS)评分、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)情况及患者的死亡率,采用Logistics回归模型分析早期神经功能改善对患者3个月结局的预测作用。结果共纳入1100例患者,在溶栓后2 h,310(28.18%)例患者具有ENI,在溶栓后24 h,272(24.73%)例患者具有ENI。在多因素Logistic回归分析模型中,调整了年龄、心房颤动病史、基线血糖水平、基线NIHSS评分水平及其他相关变量后发现,无论是溶栓后2 h还是溶栓后24 h,ENI组患者与非-ENI组患者相比,均具有更好的3个月良好功能结局(2 h:OR 3.772;95%CI 2.676~5.316,P0.001;24 h:OR 16.392;95%CI 10.370~25.912,P0.001)以及更低的死亡率(2 h:OR 0.504;95%CI 0.268~0.950,P=0.034;24 h:OR 0.149;95%CI 0.061~0.366,P0.001),同时,其出血风险(2 h:OR 1.979;95%CI 0.621~6.301,P=0.248;24 h:OR-;95%CI-,P=0.928)均未增加。结论静脉注射重组组织纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)溶栓后早期神经功能改善的缺血性卒中患者具有更加良好的3个月功能预后。     

低钾血症和低钠血症对急性缺血性脑卒中溶栓患者短期预后的影响

目的研究低钾血症和低钠血症对急性缺血性脑卒中溶栓患者短期预后的影响。方法选取2018年11月～2019年5月于抚顺市中心医院收治的住院并且接受静脉溶栓治疗的患者共108例,其中急性缺血性脑卒中患者(45例),急性缺血性脑卒中伴低钠血症患者(36例),急性缺血性脑卒中伴低钾血症(27例),比较三组患者溶栓前,溶栓后24 h、3d的美国国立卫生研究院卒中量表(NIHSS)评分,溶栓后14 d改良Rankin量表(mRs)评分及出血转化率是否有差异。再将低钾血症组分为A组(轻度低钾)、B组(中度低钾)、C组(重度低钾),低钠血症组分为a组(轻度低钠)、b组(中度低钠)、c组(重度低钠),分别比较各组间溶栓前,溶栓后24 h、3d的NIHSS评分,溶栓后14 d mRs评分是否有差异。结果三组患者溶栓前NIHSS评分不存在显著差异(P>0.05),三组患者溶栓后24 h、3d的NIHSS评分及14 d后mRs评分均有所下降,其中伴有低钠血症的溶栓患者下降幅度不如其他两组,差异有统计学意义(P<0.05),出血转化率三组不存在显著差异(P>0.05)。A、B、C三组在溶栓前,溶栓后24 h,3d的NIHSS评分,溶栓后14 d mRs评分上差异均无统计学意义(P>0.05)。a、b、c三组比较,溶栓后24 h、3d的NIHSS评分,溶栓后14 d mRs评分差异存在统计学意义(P<0.05)。结论低钠血症对急性缺血性脑卒中溶栓患者短期预后存在不良影响,且血钠浓度越低,影响越大。     

急性脑梗死静脉溶栓患者出血转化及预后的危险因素研究

目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓后出血转化及预后的危险因素.方法 选择2017年6月-2019年6月211例进行静脉溶栓治疗的AIS患者为研究对象,其中出血转化(hemorrhagic tromsformation,HT)的34例患者记为HT组,未出血转化的177...     

Should IV Thrombolysis be given in Patients with Suspected Ischemic Stroke but Unknown Symptom Onset and Without Diffusion-Weighted Imaging Lesion? – Results of a Case-Control Study

BackgroundMany acute ischemic stroke (AIS) patients present with unknown time of symptom onset (UTO). In these situations, wake-up MRI protocols can guide treatment decisions: patients with DWI (diffusion-weighted imaging) but no fluid-attenuated inversion recovery lesion were shown to benefit from IVT (intravenous thrombolysis). However, initial MRI of some stroke patients is DWI negative, leaving it unclear whether this subgroup profits from IVT. Therefore, we aimed to compare the safety and efficacy of IVT in wake-up AIS patients with or without a DWI lesion in initial imaging.MethodsWe performed a case-control study. All AIS patients with UTO who underwent wake-up MRI and were treated with IVT at a German University Hospital from 2013 to 2017 were included. Patients without (DWI-) were compared to patients with DWI lesion (DWI+) regarding clinico-radiological characteristics, adverse events, and outcome at discharge. Likely stroke mimics were excluded.ResultsEleven DWI- and 32 DWI+ patients were included. There were no statistically significant differences regarding functional scores, age, sex, door-to-needle time, bleeding complications, and death. DWI+ patients more frequently had anterior circulation stroke (P = .049) and higher modified Rankin Scale (mRS) scores at discharge (P = .048). Solely in the DWI+ group 3 bleeding complications (2 asymptomatic hemorrhagic transformations, 1 muscle hematoma) and 3 deaths occurred (P = .29). A favourable outcome (mRS≤ 2) was achieved in 82% of the DWI- and in 58% of the DWI+ group (p > .05).ConclusionsOur data suggest that IVT may be used in DWI- patients with UTO with acute neurological symptoms very likely to be related to AIS.     

急诊启动急性缺血性脑卒中静脉内溶栓治疗对开始溶栓平均时间的影响及其安全性探讨

目的探索急性缺血性脑卒中(AIS)患者在神经内科急诊接受静脉内溶栓和传统收住至病房或卒中单元后接受静脉内溶栓对开始溶栓平均时间(DTN)的影响及其安全性。方法对2012年4月至2015年6月收治的176例AIS患者进行回顾性病例对照分析,比较急诊室启动溶栓组(94例)和病房启动溶栓组(82例)的DTN时间和安全性等指标,包括两组的治疗7 d时和治疗后3个月的病死率、溶栓后24 h症状性出血转化率等。结果两组基线特征差异无统计学意义(P0.05)。急诊溶栓组DTN时间(99.3±47.8)min显著短于病房溶栓组(118.8±53.2)min,P=0.014;治疗后24 h两组安全性比较,症状性颅内出血转化率差异无统计学意义(P0.05),治疗后7 d和3个月两组病死率差异无统计学意义(P0.05);两组溶栓治疗后7 d用美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分(m RS)和溶栓治疗3个月恢复良好(m RS2分)的比例差异无统计学意义(P0.05)。结论在急诊启动静脉内溶栓治疗AIS能明显缩短DTN,安全性与送入病房后再进行静脉内溶栓治疗差异无显著性,AIS的静脉内溶栓治疗应在急诊尽快启动,若急诊空间有限,溶栓和送入病房可同时进行(Drip-and-Ship)。     

替罗非班治疗急性脑梗死静脉溶栓后24 h内不明原因早期神经功能恶化的临床研究

目的 探讨经阿替普酶静脉溶栓治疗的急性脑梗死患者在24 h内发生不明原因早期神经功能恶化(unexplained early neurological deterioration,Unexplained END)后应用替罗非班治疗的有效性和安全性。方法 回顾性分析2015年1月-2020年1月于南通大学第二附属医院急诊神经内科确诊为急性脑梗死,并在静脉溶栓时间窗内应用阿替普酶进行溶栓治疗后24 h内发生不明原因早期神经功能恶化的患者,根据是否应用替罗非班进行干预分为应用替罗非班干预的治疗组和常规治疗的对照组。应用美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评估2组患者在干预后第24 h、第7 d的神经功能缺损程度,并于出院后第90 d应用改良的Rankin量表(Modified Rankin scale,mRS)对所有患者的生活能力恢复情况进行评估,以mRS评分较出院时>2分为预后不良,mRS评分≤2分为预后良好,住院期间评估所有患者是否存在出血转化,出院后90 d是否存在死亡病例。结果 共纳入73例经静脉溶栓后发生不明原因END的急性脑梗死患者,其中男53(72.6%)例,女20(27.4%)例,平均年龄(63.33±4.53)岁,治疗组31(42.5%)例,对照组42(57.5%)例。治疗组在干预后的第24 h和第7 d的NIHSS评分均低于对照组(P<0.05); 治疗组出院后90 d预后良好的比例明显高于对照组(P<0.05)。治疗组出现2例出血转化,2组均未出现死亡病例。结论 对于经阿替普酶静脉溶栓后的急性脑梗死患者所出现的END及时应用替罗非班进行干预安全有效。     

急性缺血性卒中围静脉溶栓时间窗临床症状波动的静脉溶栓研究

目的 探讨急性缺血性卒中患者围静脉溶栓时间窗临床症状波动的患者进行静脉溶栓治疗的临 床特征及预后分析。 方法 前瞻性纳入绵阳市中心医院2013年10月-2018年6月连续登记的发病4.5 h内进行静脉溶栓的 患者,以实施静脉溶栓时NIHSS评分较入院时NIHSS评分上下波动2分作为临床症状波动判断标准,将 所有纳入患者分为无变化组、波动组。分析比较两组患者的临床特征及24 h出血转化率、出院NIHSS 评分、3个月预后良好（mRS评分≤2分）和全因死亡率,多因素Logistic回归分析围静脉溶栓时间窗发生 临床症状波动的影响因素。 结果 共纳入156例,其中男性110例（70.5%）,年龄范围42～87岁,平均65±13岁,发生围静脉 溶栓时间窗临床症状波动41例（26.3%）。与无变化组患者相比,波动组患者年龄、基线NIHSS评 分、糖尿病比例、高血压比例、随机血糖水平、后循环梗死比例较高,差异均具有统计学意义。两 组患者的24 h出血转化率、出院NI HSS评分、3个月良好预后率、3个月时全因死亡率差异无统计学意 义。Logistic回归分析发现年龄（每增加10岁：OR 1.143,95%CI 1.016～1.836,P =0.040）、基线NIHSS 评分（每增加1分：OR 1.353,95%CI 1.053～1.393,P =0.006）、随机血糖（每增加1 mmol/L：OR 2.120, 95%CI 1.185～2.748,P =0.001）、后循环梗死（OR 2.603,95%CI 1.037～3.950,P =0.042）是围静脉 溶栓时间窗临床症状波动的独立危险因素。 结论 尽管高龄、NIHSS评分高、血糖水平高、后循环梗死患者容易出现围静脉溶栓时间窗临床症 状波动,但对终点事件并无影响。对于出现临床症状波动的患者,溶栓可使患者获益。     

Thrombectomy or intravenous thrombolysis in patients with NIHSS of 5 or less?

Background and purposeTo compare outcomes of minor stroke patients with intracranial vessel occlusions (IVO) underwent mechanical thrombectomy (MT) versus those treated with intravenous thrombolysis alone (IVT).MethodsWe retrospectively reviewed two large prospective stroke databases from two European centers searching for patients admitted with minor stroke (i.e. NIHSS Score░≤░5), baseline mRS░=░0 and occlusion of the M1–M2 segment of the middle cerebral artery (MCA). Groups receiving (A) IVT alone and (B) MT+/-IVT were compared. Primary outcome measures were MT safety, successful recanalization rate (mTICI 2b-3) and NIHSS shift (discharge NIHSS minus admission NIHSS); secondary outcomes included discharge rates and excellent outcome (mRS 0-1) at 3 months. Univariate and multivariate analyses were performed.ResultsThirty-two patients were enrolled in Group B (19░MT alone; 13 MT░+░IVT) and 24 in Group A. Successful recanalization (mTICI 2b-3) was obtained in 100% of cases in Group B vs 38% in Group A. Symptomatic hemorrhagic transformation rate did not differ between the two groups. Multivariate analysis reported MT as the only predictor of early (<░12░h) favorable NIHSS shift and lower NIHSS at discharge. Moreover, discharge at home and excellent outcome at 3-month follow-up were statistically associated with MT.ConclusionsMT in patients with minor strokes and intracranial vessel occlusion (IVO) is safe and can determine a rapid improvement of NIHSS Score. MT seems also associated with a higher rate of patients discharged at home after hospitalization and better clinical outcome at 3-month follow-up. Larger randomized trials are warranted to confirm these results.     

Intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke in a local university hospital]

Thrombolytic therapy for ischemic stroke has not been approved in Japan yet. However, we have used intravenous t-PA for acute ischemic stroke patients. We reviewed the clinical data on patients who were treated with intravenous t-PA and entered in the stroke registry of our hospital between April 1999 and March 2004. Of 408 acute ischemic stroke patients, 20 patients (mean age 73.6 +/- 10.9, male 15, female 5) were given intravenous t-PA (alteplase in 18 patients and monteplase in two patients). The baseline NIH Stroke Scale (NIHSS) and Japan Stroke Scale (JSS) scores were 17.5 (median) and 13.3 +/- 7.6 (mean), respectively. The NIHSS and JSS at discharge were 12.5 and 12.1 +/- 11.8, respectively. Symptomatic intracerebral hemorrhage occurred in one patient. The rate of favorable outcome (mRS 0-3) at 90 days was 40%. The rate of favorable outcome at 90 days in our study was lower than that in reported randomized trials of intravenous t-PA, such as the NINDS study or the ATIANTIS trial, perhaps because age and baseline severity were higher in our patients than in the subjects in these trials. Another reason may be the dose of t-PA. As we concerned about the occurrence of symptomatic intracranial hemorrhage and there are no data on appropriate dose of t-PA for Japanese patients, the dose of t-PA that we used was 0.4 mg/kg in most patients. Although five patients died in our study, the cause of death in four patients was not hemorrhagic transformation but deteriorating ischemic infraction. The dose of t-PA that we used may have been safe but a little low for thrombolysis.     

The hemodynamic status within 24?h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke

A rapid and complete recanalization of the occluded artery is the ideal goal when intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is administrated to patients with acute ischemic stroke, i.e., limiting the ongoing ischemia to achieve a better outcome. We explored the effect of complete versus partial recanalization of the occluded intracranial artery after IV thrombolysis on the infarct growth and evaluated the functional impact. Using diffusion-weighted (DWI) volumetric measurements before rt-PA administration (DWI(1)) and 24?h later (DWI(2)), we calculated the infarct growth in 36 consecutive patients with ischemic stroke treated with IV rt-PA, with the formula DWI(2)/DWI(1). Recanalization of the affected artery was assessed by transcranial Doppler (TCD) and magnetic resonance angiography (MRA) within 24?h of stroke onset. Three patients were eliminated from the analysis; 33?patients were fully analyzed (men: n?=?23; mean (SD) age: 72.4?±?16?years; time from stroke onset to rt-PA: 179?±?54?min; mean NIHSS score at admission: 17). Patients achieving full recanalization by TCD had a smaller infarct growth, compared to those who had a partial or persistent occlusion after thrombolysis: 1.86 versus 2.91 (P?=?0.017). This difference was not significant using MRA criteria: 2.01 versus 2.69 (P?=?0.193). In the regression analysis, complete recanalization by TCD was an independent predictor of infarct growth (P?=?0.045). Thus, complete recanalization measured by TCD within 24?h of IV thrombolysis was independently associated with smaller infarct growth.     

Migraine History: A Predictor of Negative Diffusion-Weighted Imaging in IV-tPA-Treated Stroke Mimics

Background: Migraine, seizures, and psychiatric disorders are frequently reported as “stroke mimics” in patients with negative diffusion-weighted imaging (DWI) after IV-tPA. We sought to determine predictors of negative DWI in suspected stroke patients treated with IV-tPA. Method: A retrospective case-control study encompassing all acute stroke patients treated with IV-tPA (at our hospital or “dripped and shipped”) from January 2013 to December 2014 was con- ducted. A total of 275 patients were identified with 47 negative DWI cases and 228 positive DWI controls. Variables including demographic factors, stroke characteristics, and clinical comorbidities were analyzed for statistical significance. A multivariate logistic regression was performed (SPSS-24) to identify predictors of negative DWI. Results: Approximately 17% of patients had negative DWI after IV-tPA. Compared to controls, migraine history independently predicted negative DWI (odds ratio [OR] 5.0 95% confidence interval [CI] 1.03-24.6, P = .046). Increasing age (OR .97 95% CI .94-.99, P = .02) and atrial fibrillation (OR .25 95% CI .08-.77, P = .01) predicted lower probability of negative DWI. Gender, admission NIHSS, treatment location, preadmission modified Rankin scale, diabetes mellitus, hypertension, hyperlipidemia, symptom side, seizure history, and psychiatric history did not predict negative DWI status. Conclusions: In our study, roughly 1 in 6 patients treated with IV-tPA were later found to be stroke mimics with negative DWI. Despite a high proportion of suspected stroke mimics in our study, only preexisting migraine history independently predicted negative DWI status after IV-tPA treatment in suspected stroke patients.