Stroke：NEST-2研究，经颅激光治疗对急性缺血性卒中无益

　　美国一项研究表明，经颅激光治疗（TLT）对急性缺血性卒中患者似乎无益。论文于5月9日在线发表于《卒中》（Stroke）。

　　此项研究（NEST-2）以发病后24小时内接受治疗的急性缺血性卒中患者为受试者，并随机给予TLT或假治疗。在第5天时分别有576和64例患者接受CT和MRI扫描。所有患者均伴有可疑皮质受累。通过总梗塞体积和Alberta卒中项目早期CT评分（ASPECTS）评估TLT对皮质的治疗影响。

　　结果显示，总ASPECTS与总梗塞体积强相关，但在总体研究人群中TLT对总梗塞体积、总ASPECTS和相关指标均无影响。在皮质可能受累的各亚组患者中TLT对梗塞体积均无影响。计划纳入1000例患者的NEST-3研究已因患者在90天转归无益而提前终止。该研究的完整结果将于5月31日在欧洲卒中大会上公布。

Transcranial Laser Therapy and Infarct Volume
Background and Purpose
Two randomized trials suggested that transcranial laser therapy (TLT) may benefit patients with acute ischemic stroke, although efficacy has not been confirmed. Supportive proof of concept could be demonstrated if TLT reduces the volume of cortical infarction.
Methods
The NeuroThera Efficacy and Safety Trial-2 (NEST-2) was a randomized trial of TLT versus sham in patients with acute ischemic stroke treated within 24 hours of onset. Infarct volumes were measured quantitatively and semiquantitatively on all protocol-required computed tomography (or MRI, if clinically indicated) scans performed on day 5 (±2). Two approaches assessed treatment effects on cortex: (1) indirectly, by analyzing total infarct volume among patients with clinical presentations suggesting cortical involvement; and (2) directly, by assessing the cortical Alberta Stroke Program Early CT Score (cASPECTS) components (M1-M6, anterior, posterior) on a 0- to 8-point modified scale.
Results
A total of 640 subjects had scans (576 computed tomography, 64 MRI) on day 5. The reliability of ASPECTS (intraclass correlation coefficient=0.85) and cASPECTS (intraclass correlation coefficient=0.82) was excellent, and total ASPECTS was correlated with total infarct volume (r=0.71). In the overall study population, there was no impact of TLT on total infarct volume (P=0.30), total ASPECTS (P=0.85), or cASPECTS (P=0.89). Similarly, no effect was seen in any of the following prespecified subgroups selected to indicate cortical involvement: baseline National Institutes of Health Stroke Scale score >10, Oxfordshire Total Anterior Circulation Syndrome, subjects with aphasia or extinction at baseline, or subjects with radiographic involvement of cortex.
Conclusions
TLT was not associated with a reduction in overall or cortical infarct volume as measured on computed tomography in the subacute phase.

原文阅读：Transcranial laser therapy unhelpful after ischemic stroke
Despite apparently encouraging initial results, transcranial laser therapy (TLT) appears to be of no benefit in patients with acute ischemic stroke.
The conclusions, reported May 9 online in Stroke by Dr. Scott E. Kasner of the University of Pennsylvania in Philadelphia and colleagues, are based on results from NEST-2, a randomized trial of TLT versus sham in patients with acute ischemic stroke treated within 24 hours of onset. That and an earlier trial suggested that the approach might be of benefit...