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首页> 外文期刊>European journal of neurology: the official journal of the European Federation of Neurological Societies >Intravenous thrombolysis for patients with reverse magnetic resonance angiography and diffusion-weighted imaging mismatch: SAMURAI and NCVC rt-PA Registries
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Intravenous thrombolysis for patients with reverse magnetic resonance angiography and diffusion-weighted imaging mismatch: SAMURAI and NCVC rt-PA Registries

机译：逆转磁共振血管造影患者静脉溶栓和扩散加权成像错配：武士和NCVC RT-PA注册表

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摘要

Background and purpose: The characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA). Methods: Patients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of <7. RMM was defined as DWI-ASPECTS <7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90 days were compared amongst the four groups. Results: Of the 486 patients enrolled (167 women, median age 74 years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS ≥ 7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS < 7 plus MAO (7.45, 2.39-23.2). Conclusion: RMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.
机译：背景论：逆转磁共振血管造影和扩散加权成像（MRA-DWI）失配（RMM）的特性定义为在没有主要动脉闭塞（MAO）的情况下的大DWI病变，尤其是患者治疗患者用静脉内重组组织纤溶酶原激活剂（RT-PA）。方法：包括中风中风患者。利用艾伯塔省中风方案的早期CT得分在DWI（DWI方面）评估早期缺血性变化（EIC）。基于MAO的存在和DWI方面的截止值<7的截止值，将所有患者分为四组。 RMM被定义为DWI方面<7没有毛泽东。在四组中比较了临床特征，症状脑出血（SICH）和有利的功能结果（改进的Rankin Scale 0-2）。结果：486名患者注册（167名女性，中位数74岁，中位数初始国家卫生冲程量表得分13），在24（5％）中观察到逆转MRA-DWI错配。在临床特征中，心脏栓塞是与RMM的唯一因素与rmm [ocds比（或）5.49,95％置信区间（CI）1.25-24.1]。多变量分析显示，rmm的患者比DWI方面更常见的患者≥7，而不论存在（或5.44,95％CI 1.13-26.1）或缺陷（13.1,2.07-83.3），他们有一个更有利的功能结果，而不是DWI方面<7加mAO（7.45,2.39-23.2）。结论：5％的患者观察到RT-PA治疗的患者rmm，与心脏栓塞相关。与毛泽东的EIC的人相比，患有RMM的患者可能会受益于溶栓分析，尽管SICH的速度是一个问题。

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    SakamotoY.; KogaM.; KimuraK.; NagatsukaK.; OkudaS.; KarioK.; HasegawaY.; OkadaY.; YamagamiH.; FuruiE.; NakagawaraJ.; ShiokawaY.; OkataT.; KobayashiJ.; TanakaE.; MinematsuK.; ToyodaK.;

  • 作者单位

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

    Department of Stroke Care Unit National Cerebral and Cardiovascular Center Suita Japan;

    Department of Stroke Medicine Kawasaki Medical School Kurashiki Japan;

    Department of Neurology National Cerebral and Cardiovascular Center Suita Japan;

    Department of Neurology National Hospital Organization Nagoya Medical Center Nagoya Japan;

    Division of Cardiovascular Medicine Jichi Medical University School of Medicine Shimotsuke;

    Department of Neurology St Marianna University School of Medicine Kawasaki Japan;

    Department of Cerebrovascular Disease National Hospital Organization Kyushu Medical Center;

    Department of Neurology Stroke Center Kobe City General Hospital Kobe Japan;

    Department of Stroke Neurology Kohnan Hospital Sendai Japan;

    Department of Neurosurgery and Stroke Center Nakamura Memorial Hospital Sapporo Japan;

    Department of Neurosurgery and Stroke Center Kyorin University School of Medicine Mitaka Japan;

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

    Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan;

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  • 正文语种 eng
  • 中图分类 神经病学;
  • 关键词

    Acute ischaemic stroke; Diffusion-weighted imaging; Early ischaemic change; Magnetic resonance angiography; Prognosis; Tissue plasminogen activator;

    机译：急性缺血性卒中;扩散加权成像;早期缺血变化;磁共振血管造影;预后;组织纤溶酶原激活剂;

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