Stroke Outcomes of Japanese Patients With Major Cerebral Artery Occlusion in the Post-Alteplase, Pre-MERCI Era

详细信息    查看全文

• 作者：Kaoru Endo ; Masatoshi Koga ; Nobuyuki Sakai ; Hiroshi Yamagami ; Eisuke Furui ; Yasushi Matsumoto ; Yoshiaki Shiokawa ; Shinichi Yoshimura ; Yasushi Okada ; Jyoji Nakagawara ; Toshio Hyogo ; Yasuhiro Hasegawa ; Hisashi Nagashima ; Toshiyuki Fujinaka ; Akio Hyodo ; Tomoaki Terada ; Kazunori Toyoda ; Joint Research Group from JR-NET2 ; SAMURAI Study Investigators
• 关键词：Acute ischemic stroke ; thrombolysis ; t-PA ; endovascular treatment
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：22
• 期：6
• 页码：805-810
• 全文大小：473 K

文摘

This study examined outcomes of patients with acute ischemic stroke (AIS) with major cerebral artery occlusion after the approval of intravenous recombinant tissue-type plasminogen activator (IV rt-PA) but before approval of the MERCI retriever. We retrospectively enrolled 1170 consecutive patients with AIS and major cerebral artery occlusion (496 women; mean age, 73.9 ¡À 12.3 years) who were admitted within 24 hours after the onset of symptoms to 12 Japanese stroke centers between October 2005 and June 2009. Cardioembolism was a leading cause of AIS in this group (68.2 % ). The occlusion sites of the major cerebral arteries included the common carotid artery and internal carotid artery (ICA; 29.6 % ), middle cerebral artery (52.2 % ), and basilar artery (7.6 % ). Recanalization therapy (RT) was performed in 32.0 % of patients (IV rt-PA, 20.0 % ; neuroendovascular therapy, 9.4 % ; combined, 2.5 % ). Symptomatic intracerebral hemorrhage within 36 hours with a ¡Ý1-point increase in the National Institutes of Health Stroke Scale score occurred in 5.3 % of the patients. At 3 months (or at hospital discharge), 29.3 % of the patients had a favorable outcome (based on a modified Rankin scale score of 0-2), 23.8 % were bedridden, and 15.6 % died. After multivariate adjustment, RT was positively associated with a favorable outcome and negatively associated with death, whereas age, baseline National Institutes of Health Stroke Scale score, and ICA occlusion were negatively associated with a favorable outcome and positively associated with death. One-third of the patients with AIS and major cerebral artery occlusion were treated with RT, which was independently associated with favorable outcomes and death. However, 40 % of the patients became bedridden or died during the post-alteplase, pre-MERCI?era in Japan.