Stroke：醒型缺血性卒中患者溶栓可行

　　英国一项研究表明，对选择性觉醒型缺血性卒中（WUIS）患者进行溶栓治疗是可行的，并且其转归与0～4.5小时进行溶栓治疗的患者相当。论文于5月30日在线发表于《卒中》（Stroke）。

　　此项研究共纳入394例符合预定标准的溶栓患者，其中326例在起病后0～4.5小时内就诊（参照组），68例为WUIS患者（在<12小时或>4.5小时最后一次观察到正常）。受试者NIHSS平均≥5，并且就诊时无或仅有早期影像学缺血性改变。主要转归指标为90天时改良Rankin量表评分为0～2，其他转归包括90天时症状性脑内出血、改良Rankin评分0～1和死亡。

　　结果显示，两组患者的平均年龄（72.8对73.9岁）和基线中位NIHSS评分（13对12）具有可比性。对年龄、卒中严重度和影像改变进行校正之后，90天时改良Rankin量表评分0～2和0～1患者比率、任意ICH和症状性脑内出血均具有可比性。仅2%（9/394）患者失访。

A Case-Controlled Comparison of Thrombolysis Outcomes Between Wake-Up and Known Time of Onset Ischemic Stroke Patients

Background and Purpose—Wake-up ischemic stroke (WUIS) patients are not thrombolysed even if they meet other criteria for treatment. We hypothesized that patients with WUIS showing no or early ischemic changes on brain imaging will have thrombolysis outcomes comparable with those with known time of symptom onset.

Methods—Consecutive sampling of a prospective registry of patients with stroke between January 2009 and December 2010 identified 394 thrombolysed patients meeting predefined inclusion criteria, 326 presenting within 0 to 4.5 hours of symptom onset (Reference Group) and 68 WUIS patients. Inclusion criteria were last seen normal <12 hours or >4.5 hours (WUIS) or presented <4.5 hours (Reference Group), had National Institutes of Health Stroke Scale score ≥5, and no or early ischemic changes on imaging at presentation. The primary outcome measure was the modified Rankin Scale of 0 to 2 at 90 days measured by trained assessors blinded to patient grouping. Other outcome measures were symptomatic intracerebral hemorrhage, modified Rankin Scale 0 to 1, and mortality at 90 days.

Results—The groups were comparable for mean age (72.8 versus 73.9 years; P=0.58) and baseline median National Institutes of Health Stroke Scale score (median 13 versus 12; P=0.34). The proportions of patients with modified Rankin Scale 0 to 2 (38% versus 37%; P=0.89) and modified Rankin Scale 0 to 1 (24% versus 16%; P=0.18) at 90 days, any ICH (20% versus 22%; P=0.42) and symptomatic intracerebral hemorrhage (3.4% versus 2.9%; P=1.0) were comparable after adjusting for age, stroke severity, and imaging changes. Only 9/394 (2%) patients were lost to follow-up.

Conclusions—Thrombolysis in selected patients with WUIS is feasible, and its outcomes are comparable with those thrombolysed with 0 to 4.5 hours.