Intravenous Thrombolysis for Acute Ischemic Stroke due to Cervical Internal Carotid Artery Occlusion

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• 作者：Leonard L.L. Yeo ; MBBS ; MRCP^* ; ^{leonard_ll_yeo@nuhs.edu.sg" class="auth_mail" title="E-mail the corresponding author} ; Wan Yee Kong ; MBBS^* ; Prakash Paliwal ; MBBS^* ; Hock L. Teoh ; MBchB^* ; Raymond C. Seet ; MBBS^* ; ^&dagger ; ; Derek Soon ; PhD^* ; Rahul Rathakrishnan ; MBBS^* ; Venetia Ong ; BDS^* ; Tsong-Hai Lee ; MBBS^&Dagger ; ; ^§ ; ; Ho-Fai Wong ; MBBS^§ ; ; ^‖ ; Bernard P.L. Chan ; MBBS^* ; Wee Kheng Leow ; PhD^¶ ; ; Cheng Yuan ; PhD^¶ ; ; Eric Ting ; MBBS^# ; Anil Gopinathan ; MBBS^# ; Benjamin Y.Q. Tan ; MBBS^* ; Vijay K. Sharma ; MBBS^* ; ^&dagger ;
• 关键词：Acute ischemic care ; intracranial collaterals ; CT angiography ; thrombolysis
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：25
• 期：10
• 页码：2423-2429
• 全文大小：313 K

文摘

Internal carotid artery (ICA) occlusions are poorly responsive to intravenous thrombolysis with tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS). Most study populations have combined intracranial and extracranial ICA occlusions for analysis; few have studied purely cervical ICA occlusions. We evaluated AIS patients with acute cervical ICA occlusion treated with IV-tPA to identify predictors of outcomes.

Methods

We studied 550 consecutive patients with AIS who received IV-tPA and identified 100 with pure acute cervical ICA occlusion. We evaluated the associations of vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and leptomeningeal collateral vessel status via 3 different grading systems, with functional recovery at 90 days, mortality, recanalization of the primary occlusion, and symptomatic intracranial hemorrhage (SICH). Modified Rankin Scale score 0-1 was defined as an excellent outcome.

Results

The 100 patients had mean age of 67.8 (range 32-96) and median NIHSS score of 19 (range 4-33). Excellent outcomes were observed in 27% of the patients, SICH in 8%, and mortality in 21%. Up to 54% of the patients achieved recanalization at 24 hours. On ordinal regression, good collaterals showed a significant shift in favorable outcomes by Maas, Tan, or ASPECTS collateral grading systems. On multivariate analysis, good collaterals also showed reduced mortality (OR .721, 95% CI .588-.888, P = .002) and a trend to less SICH (OR .81, 95% CI .65-1.007, P = .058). Interestingly, faster treatment was also associated with favorable functional recovery (OR 1.028 per minute, 95% CI 1.010-1.047, P = .001).

Conclusions

Improved outcomes are seen in patients with early acute cervical ICA occlusion and better collateral circulation. This could be a valuable biomarker for decision making.