Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 Hours 英文参考文献.docVIP

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Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 Hours 英文参考文献.doc

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Safety and Clinical Outcome of Thrombolysis in Ischaemic Stroke Using a Perfusion CT Mismatch between 3 and 6 Hours 英文参考文献

SafetyandClinicalOutcomeofThrombolysisin IschaemicStrokeUsingaPerfusionCTMismatch between3and6Hours LaszloK.Sztriha1*,DulkaManawadu1,JozefJarosz2,JeffKeep3,LalitKalra1 1DepartmentofClinicalNeuroscience,InstituteofPsychiatry,King’sCollegeLondon,London,UnitedKingdom,2DepartmentofNeuroradiology,King’sCollegeHospital, London,UnitedKingdom,3GeneralandEmergencyMedicine,King’sCollegeHospital,London,UnitedKingdom Abstract Objective: It may be possible to thrombolyse ischaemic stroke (IS) patients up to 6h by using penumbral imaging. We investigatedwhetheraperfusionCT(CTP)mismatchcanhelptoselectpatientsforthrombolysisupto6h. Methods: A cohort of 254 thrombolysed IS patients was studied. 174 (69%) were thrombolysed at 0–3h by using non- contrastCT(NCCT),and80(31%)at3–6h(35at3–4.5hand45at4.5–6h)byusingCTPmismatchcriteria.Symptomatic intracerebral haemorrhage (SICH), the mortality and the modified Rankin Score (mRS) were assessed at 3 months. Independentdeterminantsofoutcomeinpatientsthrombolysedbetween3and6hwereidentified. Results: The baseline characteristics were comparable in the two groups. There were no differences in SICH (3% v 4%, p=0.71), any ICH (7% v 9%, p=0.61), or mortality (16% v 9%, p=0.15) or mRS 0–2 at 3 months (55% v 54%, p=0.96) betweenpatientsthrombolysedat0–3h(NCCTonly)orat3–6h(CTPmismatch).Therewerenosignificantdifferencesin outcomebetweenpatientsthrombolysedat3–4.5hor4.5–6h.TheNIHSSscorewastheonlyindependentdeterminantof amRSof0–2at3months(OR0.89,95%CI0.82–0.97,p=0.007)inpatientstreatedusingCTPmismatchcriteriabeyond3h. Conclusions:TheuseofaCTPmismatchmodelmayhelptoguidethrombolysisdecisionsupto6hafterISonset. Citation:SztrihaLK,ManawaduD,JaroszJ,KeepJ,KalraL(2011)SafetyandClinicalOutcomeofThrombolysisinIschaemicStrokeUsingaPerfusionCTMismatch between3and6Hours.PLoSONE6(10):e25796.doi:10.1371/journal.pone.0025796 Editor:OlivierBaud,Ho?pitalRobertDebre′,France ReceivedJuly15,2011;AcceptedSeptember11,2011;PublishedOctober10,2011 Copyright: ? 2011 Sztriha e