Stroke:轻度缺血性中风患者需要重视么?这些特征请牢记!

2021-11-12 MedSci原创 MedSci原创

据报道,三分之一的轻度脑卒中发生早期神经系统恶化,主要是由于存在相关的颅内闭塞。

据报道,三分之一的轻度脑卒中发生早期神经系统恶化,主要是由于存在相关的颅内闭塞。近期来自迈阿密神经病学系的专家开展了一项前瞻性研究,评估了这些患者的血管闭塞模式、血栓特征和再通率。相关结果发表在Stroke杂志上。

INTERRSeCT是一项多中心的前瞻性研究,研究对象为有明显颅内闭塞的急性缺血性脑卒中,在参加研究的患者中,比较了轻度(美国国立卫生研究院卒中量表评分,NIHSS≤5)和中度/重度脑卒中的特点。

在575名患者中,12.9%的患者的NIHSS评分≤5分(中位年龄,70.5[63-79];58%为男性;NIHSS,4[2-4])。两组的人口统计学和血管危险因素相似。与NIHSS评分>5分的患者相比,轻度患者从症状发作到评估的时间更长(从发病到CT检测[240分钟 vs 167分钟]和CTA[246分钟 vs 172分钟]),更多的远端闭塞(M3,大脑前动脉和大脑后动脉:22% vs 6%),更高的血栓负担评分(中位数,9[6-9] vs6[4-9]),但相似的有利血栓渗透性(残余流量I-II级,21%vs 19%),更高的侧支流量(9.1 vs 7.6),以及较低的静脉注射阿替普酶治疗率(55% vs85%)。

与中度/重度中风(26%;使用阿替普酶为29%)相比,轻度患者更有可能重新通畅(修订的动脉闭塞评分2b/3,45%;使用阿替普酶为49%)。在对性别、阿替普酶、残余血流和两次血管成像之间的时间进行调整后的模型中,静脉注射阿替普酶(OR=3.80[95%CI,1.11-13.00])和残余血流等级(OR=8.70[95%CI,1.26-60.13])与轻型患者的成功再通有关。

INTERRSeCT试验研究结果图示

由此可见,与中度/重度卒中相比,可见颅内闭塞的轻度卒中有不同的血管闭塞模式,但血栓渗透性相似。较高的血栓通透性和阿替普酶的使用与成功再通有关,尽管大多数人没有再通。需要进行随机对照试验来评估新的溶栓剂和血管内治疗对这一人群的疗效。

 

参考文献:

Radiographic Characteristics of Mild Ischemic Stroke Patients With Visible Intracranial Occlusion: The INTERRSeCT Study. https://doi.org/10.1161/STROKEAHA.120.030380. Stroke. 2021;0:STROKEAHA.120.030380

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    2021-11-12 yangchou

    好文章,谢谢分享。

    0

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    2021-11-12 ms7000001261292141

    0

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    2021-11-12 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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