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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Safety and Efficacy of Intravenous Thrombolytic Therapy in Patients With Acute Posterior Circulation Stroke: A Single-Center Study
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Safety and Efficacy of Intravenous Thrombolytic Therapy in Patients With Acute Posterior Circulation Stroke: A Single-Center Study

机译：静脉溶栓治疗急性后循环中风患者的安全性和有效性：单中心研究

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Background and Purpose: The safety and efficacy of intravenous thrombolytic therapy (IVT) for posterior circulation stroke (PCS) in the real world are rarely studied. This study was designed to evaluate the prestroke and baseline characteristics, stroke subtypes, complications, and outcomes of PCS patients and compare them with anterior circulation stroke (ACS) after intravenous thrombolysis. Methods: Data of consecutive patients with PCS and ACS treated with alteplase in a standard dose of 0.9 mg/kg in our stroke center were collected and analyzed retrospectively. Presenting characteristics, hemorrhage transformation, mortality, and favorable outcomes (modified Rankin scale 0 or 1) at 90 days were compared between PCS and ACS patients. Results: A total of 462 patients were included in this study, including 350 (75.8%) in ACS group and 112 (24.2%) in PCS group. A history of coronary artery disease was significantly more common in ACS patients than that in PCS patients (15.1% versus 6.3%, P=.015). There was no significant difference in fast glucose and baseline NIHSS scores between PCS and ACS groups. In PCS group, 7 patients (6.3%) had hemorrhage transformation after IVT and 5 patients (4.5%) were symptomatic versus 32 (9.1%) and 22 (6.3%) in ACS group (P >. 05). 75.5% PCS patients versus 72.2% ACS patients had excellent recovery outcomes (mRS 0-1) at 90 days (P = .507). For PCS patients, logistic regression analysis after adjusting the covariates identified age (P = .047, OR.920, 95% CI = .847-.999) and atrial fibrillation (P = .007, OR 12.149, 95% CI = 1.966-75.093) as independent significant predictors of hemorrhage transformation. In addition, atrial fibrillation was also an independent predictor of symptomatic intracranial hemorrhage (P = .008, OR 21.176, 95% CI = 2.228-201.273). Multivariate logistic analysis identified hemorrhage transformation (P = .012; OR.131, 95% CI = .027-.644) and onset to drug time (P = .026, OR 1.006, 95% CI = 1.001-1.011) as independent predictors of functional independence (mRS 0-2). Symptomatic intracranial hemorrhage (P = .007, OR 15.094, 95% CI = 2.097-108.661) and baseline NIHSS score (P = .050; OR 1.070, 95% CI = 1.000-1.145) were independent predictors of mortality. Conclusion: Our results suggest that IVT in PCS patients is safe and effective as that in ACS patients. In PCS patients, long onset to needle time and hemorrhage transformation were identified as independent predictors of unfavorable outcomes.
机译：背景和目的：在现实世界中，静脉溶栓治疗（IVT）治疗后循环卒中（PCS）的安全性和有效性很少被研究。本研究旨在评估PCS患者的卒中前和基线特征、卒中亚型、并发症和预后，并将其与静脉溶栓后的前循环卒中（ACS）进行比较。方法：收集并回顾性分析在我们的卒中中心连续接受0.9 mg/kg标准剂量阿替普酶治疗的PCS和ACS患者的数据。比较PCS和ACS患者在90天时的表现特征、出血转化、死亡率和良好预后（改良Rankin评分0或1）。结果：本研究共纳入462例患者，其中ACS组350例（75.8%），PCS组112例（24.2%）。ACS患者的冠状动脉病史明显高于PCS患者（15.1%对6.3%，P=0.015）。PCS组和ACS组之间的快速血糖和基线NIHSS评分没有显著差异。PCS组有7例（6.3%）IVT后出现出血转化，5例（4.5%）有症状，而ACS组有32例（9.1%）和22例（6.3%）（P>0.05）。75.5%的PCS患者和72.2%的ACS患者在90天时恢复良好（mRS 0-1）（P=0.507）。对于PCS患者，调整协变量后的逻辑回归分析将年龄（P=0.047，OR.920，95%CI=0.847-.999）和心房颤动（P=0.007，OR 12.149，95%CI=1.966-75.093）确定为出血转化的独立显著预测因子。此外，心房颤动也是症状性颅内出血的独立预测因子（P=0.008，或21.176，95%可信区间=2.228-201.273）。多变量logistic分析确定出血转化（P=0.012；OR.131，95%可信区间=0.027-.644）和起效至服药时间（P=0.026，OR 1.006，95%可信区间=1.001-1.011）是功能独立性的独立预测因子（mRS 0-2）。症状性颅内出血（P=0.007或15.094，95%可信区间=2.097-108.661）和基线NIHSS评分（P=0.050；或1.070，95%可信区间=1.000-1.145）是死亡率的独立预测因子。结论：我们的结果表明，PCS患者的IVT与ACS患者一样安全有效。在PCS患者中，长起病时间和出血转化被认为是不良预后的独立预测因素。

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