医学
溶栓
改良兰金量表
尿激酶
内科学
冲程(发动机)
组织纤溶酶原激活剂
心脏病学
缺血性中风
缺血
心肌梗塞
机械工程
工程类
作者
A-Hyun Cho,Sung‐Il Sohn,Moon Ku Han,Deok Hee Lee,Jong Sung Kim,Choong Gon Choi,Chul‐Ho Sohn,Sun U. Kwon,Dae Chul Suh,Sang Joon Kim,Hee‐Joon Bae,Dong‐Wha Kang
出处
期刊:Cerebrovascular Diseases
[S. Karger AG]
日期:2008-01-01
卷期号:25 (6): 572-579
被引量:94
摘要
<i>Background:</i> Standard selection criteria for thrombolysis typically exclude patients with acute ischemic stroke with unclear onset. Multimodal MRI screening may be able to identify those with a favorable benefit-risk ratio for thrombolysis. We aimed to evaluate the safety and efficacy of MRI-based thrombolysis in unclear-onset stroke (UnCLOS). <i>Methods:</i> We reviewed the thrombolysis database registries from 3 medical centers in Korea. Subjects received thrombolysis with intravenous tissue plasminogen activator (tPA) or combined intravenous tPA and intra-arterial urokinase within 3 h, or intra-arterial urokinase within 6 h from symptom detection. For patients with UnCLOS, MRI-specific eligibility criteria (i.e. positive perfusion-diffusion mismatch and absence of well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions) were applied. Rates of immediate and 5-day recanalization, early neurological improvement and symptomatic intracranial hemorrhage (ICH) within 48 h after treatment and 3-month modified Rankin Scale (mRS) scores were compared between patients with UnCLOS and those with clear-onset stroke (CLOS). <i>Results:</i> 32 patients with UnCLOS and 223 patients with CLOS were included. Baseline characteristics were comparable between the two groups, except that the proportion of MRI screening was higher, and detection-to-door time and door-to-needle time were longer in the UnCLOS group (p < 0.01). Rates of recanalization (immediate, 81.3 vs. 63.1%; delayed, 80.6 vs. 69.1%), early neurological improvement (on day 1, 46.9 vs. 35.9%; on day 7, 50.0 vs. 49.3%), symptomatic ICH (6.3 vs. 5.8%) and 3-month outcome (mRS 0–1, 37.5 vs. 35.0%; mRS 0–2, 50.0 vs. 49.3%) did not differ between the UnCLOS and CLOS groups. <i>Conclusion:</i> These preliminary results suggest that thrombolysis based on MRI criteria may safely be applied to acute stroke patients with unclear onset.
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