Background： Early neurological deterioration （END） is a prominent issue after recanalization treatment. However. few studies have reported the characteristics of END after endovascular treatment （EVT） as so far. ...Background： Early neurological deterioration （END） is a prominent issue after recanalization treatment. However. few studies have reported the characteristics of END after endovascular treatment （EVT） as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator （IV rt-PA） and EVT of acute ischemic stroke, and identified risk factors for END. Methods： Medical records of patients who received recanalization treatment between January l, 2014, and December 31, 2015 were reviewed. Patients were classified into IV rt-PA or EVT group according to the methods ofrecanalization treatment. The END was defined as an increase in the National Institutes of Health Stroke Scale （N1HSS） ≥4 or an increase in la of NIHSS ≥I within 72 h after recanalization treatment. Clinical data were compared between the END and non-END subgroups within each recanalization group. Results： Of the 278 patients included in the study, the incidence of END was 34.2%. The incidence rates of END were 29.8% in the IV rt-PA group and 40.2% in the EVT group, lschemia progression （68.4%） was the main contributor to END followed by vasogenic cerebral edema （21. 1%） and symptomatic intracranial hemorrhage （10.5%）. Multivariate logistic regression showed that admission systolic blood pressure （SBP） ≥160 mmHg （odds ratio [OR]： 2.312, 95% confidence interval [CI]： 1.105-4.837） and large artery occlusion after IV rt-PA （OR： 3.628.95% （7： 1.482-8.881 ） independently predicted END after IV rt-PA; and admission SBP 〉 140 mmHg （OR： 5.183, 95% CI：1.967 13.661 ）, partial recanalization （OR： 4.791,95% CI： 1.749-13.121 ）, and nonrecanalization （OR： 5.952, 95% CI： 1.841-19.243） independently predicted END alter EVT. The mortality rate and grave outcome rate at discharge of all the END patients （26.3% and 55.8%） were higher than those of all the non-END patients （1.1% and 18.6%： P 〈 0.01）. Conclusions： END was not an uncommon event and associated with death and grave outcome at discharge. High admission SBP and unsatisfactory recanalization of occluded arteries might predict END.展开更多
Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical ...Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources： Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2＊, thrombolysis, recombinant tissue plasminogen activator （rt-PA）, thrombolytic therapy, and stroke. Study Selection： Papers in EngLish or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors＇ files. Results： SW1 is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign （SVS） on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectonqy in combination or alone. SW1 is sensitive in detecting cerebral microbleed （CMB）, and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple loci could possibly be related to intracranial hemorrhage （ICH） after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions： It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.展开更多
文摘Background： Early neurological deterioration （END） is a prominent issue after recanalization treatment. However. few studies have reported the characteristics of END after endovascular treatment （EVT） as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator （IV rt-PA） and EVT of acute ischemic stroke, and identified risk factors for END. Methods： Medical records of patients who received recanalization treatment between January l, 2014, and December 31, 2015 were reviewed. Patients were classified into IV rt-PA or EVT group according to the methods ofrecanalization treatment. The END was defined as an increase in the National Institutes of Health Stroke Scale （N1HSS） ≥4 or an increase in la of NIHSS ≥I within 72 h after recanalization treatment. Clinical data were compared between the END and non-END subgroups within each recanalization group. Results： Of the 278 patients included in the study, the incidence of END was 34.2%. The incidence rates of END were 29.8% in the IV rt-PA group and 40.2% in the EVT group, lschemia progression （68.4%） was the main contributor to END followed by vasogenic cerebral edema （21. 1%） and symptomatic intracranial hemorrhage （10.5%）. Multivariate logistic regression showed that admission systolic blood pressure （SBP） ≥160 mmHg （odds ratio [OR]： 2.312, 95% confidence interval [CI]： 1.105-4.837） and large artery occlusion after IV rt-PA （OR： 3.628.95% （7： 1.482-8.881 ） independently predicted END after IV rt-PA; and admission SBP 〉 140 mmHg （OR： 5.183, 95% CI：1.967 13.661 ）, partial recanalization （OR： 4.791,95% CI： 1.749-13.121 ）, and nonrecanalization （OR： 5.952, 95% CI： 1.841-19.243） independently predicted END alter EVT. The mortality rate and grave outcome rate at discharge of all the END patients （26.3% and 55.8%） were higher than those of all the non-END patients （1.1% and 18.6%： P 〈 0.01）. Conclusions： END was not an uncommon event and associated with death and grave outcome at discharge. High admission SBP and unsatisfactory recanalization of occluded arteries might predict END.
文摘Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources： Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2＊, thrombolysis, recombinant tissue plasminogen activator （rt-PA）, thrombolytic therapy, and stroke. Study Selection： Papers in EngLish or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors＇ files. Results： SW1 is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign （SVS） on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectonqy in combination or alone. SW1 is sensitive in detecting cerebral microbleed （CMB）, and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple loci could possibly be related to intracranial hemorrhage （ICH） after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions： It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
