Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke.

背景与目的：静脉内组织重组纤溶酶原（t-PA）进行溶栓治疗能够改善急性缺血性中风患者的状况，但如无法早期再通则使治疗的效果降低。

方法：我们对采用t-PA治疗的急性中风患者进行了回顾性研究，并对一系列与早期再通有关的因子进行了检测，包括MRA。在t-PA使用前后24小时进行NIHSS评分。

结果：研究对49位采用t-PA治疗的中风患者进行了连续观察。T-PA给药前进行的MRA证明37名患者存在动脉堵塞。在这37份病例中，t-PA给药后30分钟完全再通的有6例，部分再通12例，无早期再通为19例。神经系统症状加重在再通组中为0例，无再通组为18例。另外，未早期再通患者发生房颤和高血压的频率也远高于再通组。但是，其他临床因子在两组间未出现显著性差异。多因回归分析显示房颤是再通与未再通间唯一的独立风险因子。

结论：t-PA给药后未早期再通约占所有急性中风患者的51.4%，且将出现严重的神经系统症状恶化。房颤独立且显著的与t-PA治疗后未再通相关。

　　（来源：J Neurol Sci. 2007 Oct 25）

Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke.

Kimura K, Iguchi Y, Yamashita S, Shibazaki K, Kobayashi K, Inoue T.

Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.

BACKGROUND AND PURPOSE: Intravenous administration of tissue plasminogen activator (t-PA) dissolves the clot and can improve clinical outcome in patients with acute ischemic stroke. However, lack of early recanalization frequently does not result in good outcome.

METHODS: We prospectively studied acute stroke patients treated with t-PA and examined clinical factors associated with no early recanalization of occluded arteries after t-PA administration using serial magnetic resonance angiography (MRA). NIHSS score was obtained before and at 24h after t-PA administration.

RESULTS: Subjects comprised 49 consecutive stroke patients treated with t-PA. Initial MRA before t-PA infusion demonstrated occluded arteries in 37 patients. Of the 37 occluded arteries, follow-up MRA within 30min after t-PA administration revealed complete recanalization in 6 patients, partial recanalization in 12, and no early recanalization in 19. Neurological worsening (total NIHSS score increased by >/=4) occurred in 0 of 18 patients with recanalization and 4 of 19 patients with no recanalization (P=0.039). Atrial fibrillation (AF) and hypertension were more frequent in patients with non-early recanalization than in patients with recanalization (73.7% vs. 38.9%, P=0.03; 73.6% vs. 38.9%, P=0.03, respectively). However, no differences were observed in other clinical factors between groups. Multivariate logistic regression analysis demonstrated AF (OR: 9.3; CI: 1.5-55.8, P=0.015) as the only independent factor associated with no recanalization.

CONCLUSION: No early recanalization after t-PA administration was observed in 51.4% of acute stroke patients with occluded arteries and was significantly associated with neurological worsening. AF was independently associated with no recanalization after t-PA administration.