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Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke: Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis.
Stroke ( IF 8.3 ) Pub Date : 2020-01-09 , DOI: 10.1161/strokeaha.119.027071
Boris Keselman 1, 2 , Zuzana Gdovinová 3 , Dalius Jatuzis 4, 5 , Teresa Pinho E Melo 6 , Aleksandras Vilionskis 4, 7 , Roberto Cavallo 8 , Senta Frol 9 , Lubomir Jurak 10 , Bahar Koyuncu 11 , Ana Paiva Nunes 12 , Alfredo Petrone 13 , Kennedy R Lees 14 , Michael V Mazya 1, 2
Affiliation  

Background and Purpose—Posterior circulation stroke (PCS) accounts for 5% to 19% of patients with acute stroke receiving intravenous thrombolysis. We aimed to compare safety and outcomes following intravenous thrombolysis between patients with PCS and anterior circulation stroke (ACS) and incorporate the results in a meta-analysis.Methods—We included patients in the Safe Implementation of Treatments in Stroke Thrombolysis Registry 2013 to 2017 with computed tomography/magnetic resonance angiographic occlusion data. Outcomes were parenchymal hematoma, symptomatic intracerebral hemorrhage (SICH) per SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study), ECASS II (Second European Co-operative Stroke Study) and NINDS (Neurological Disorders and Stroke definition), 3-month modified Rankin Scale score, and death. Adjustment for SICH risk factors (age, sex, National Institutes of Health Stroke Scale, blood pressure, glucose, and atrial fibrillation) and center was done using inverse probability treatment weighting, after which an average treatment effect (ATE) was calculated. Meta-analysis of 13 studies comparing outcomes in PCS versus ACS after intravenous thrombolysis was conducted.Results—Of 5146 patients, 753 had PCS (14.6%). Patients with PCS had lower median National Institutes of Health Stroke Scale: 7 (interquartile range, 4–13) versus 13 (7–18), P<0.001 and fewer cerebrovascular risk factors. In patients with PCS versus ACS, parenchymal hematoma occurred in 3.2% versus 7.9%, ATE (95% CI): −4.7% (−6.3% to 3.0%); SICH SITS-MOST in 0.6% versus 1.9%, ATE: −1.4% (−2.2% to −0.7%); SICH NINDS in 3.1% versus 7.8%, ATE: −3.0% (−6.3% to 0.3%); SICH ECASS II in 1.8% versus 5.4%, ATE: −2.3% (−5.3% to 0.7%). In PCS versus ACS, 3-month outcomes (70% data availability) were death 18.5% versus 20.5%, ATE: 6.0% (0.7%–11.4%); modified Rankin Scale score 0–1, 45.2% versus 37.5%, ATE: 1.7% (−6.6% to 3.2%); modified Rankin Scale score 0–2, 61.3% versus 49.4%, ATE: 2.4% (3.1%–7.9%). Meta-analysis showed relative risk for SICH in PCS versus ACS being 0.49 (95% CI, 0.32–0.75).Conclusions—The risk of bleeding complications after intravenous thrombolysis in PCS was half that of ACS, with similar functional outcomes and higher risk of death, acknowledging limitations of the National Institutes of Health Stroke Scale for stroke severity or infarct size adjustment.

中文翻译:

后路和前循环中风的静脉溶栓治疗的安全性和结果:安全实施中风登记和荟萃分析治疗的结果。

背景与目的-后循环中风(PCS)占接受静脉溶栓治疗的急性中风患者的5%至19%。我们的目的是比较PCS和前循环卒中(ACS)患者在静脉溶栓后的安全性和结局,并将结果纳入荟萃分析。方法—我们将患者纳入2013年至2017年的《中风溶栓治疗注册安全实施方案》中,计算机体层摄影/磁共振血管造影闭塞数据。结果为实质性血肿,根据SITS-MOST(在卒中监测研究中安全实施溶栓治疗),有症状的脑出血(SICH),ECASS II(第二次欧洲合作卒中研究)和NINDS(神经系统疾病和卒中定义),三个月修改Rankin量表评分和死亡。使用逆概率治疗权重对SICH危险因素(年龄,性别,美国国立卫生研究院卒中量表,血压,葡萄糖和心房颤动)和中心进行调整,然后计算平均治疗效果(ATE)。对13项研究进行了荟萃分析,比较了静脉溶栓后PCS与ACS的结局。结果—在5146例患者中,753例患有PCS(14.6%)。PCS患者的国立卫生研究院卒中量表的中位数较低:7(四分位间距,4-13)比13(7-18),对13项研究进行了荟萃分析,比较了静脉溶栓后PCS与ACS的结局。结果—在5146例患者中,753例患有PCS(14.6%)。PCS患者的国立卫生研究院卒中量表的中位数较低:7(四分位间距,4-13)比13(7-18),对13项研究进行了荟萃分析,比较了静脉溶栓后PCS与ACS的结局。结果—在5146例患者中,753例患有PCS(14.6%)。PCS患者的国立卫生研究院卒中量表的中位数较低:7(四分位间距,4-13)比13(7-18),P<0.001且脑血管危险因素更少。PCS与ACS患者的实质血肿发生率分别为3.2%和7.9%,ATE(95%CI):− 4.7%(−6.3%至3.0%);SICH SITS-MOST分别为0.6%和1.9%,ATE:-1.4%(-2.2%至-0.7%);SICH NIND分别为3.1%和7.8%,ATE:-3.0%(-6.3%至0.3%);SICH ECASS II的1.8%对5.4%,ATE:-2.3%(-5.3%至0.7%)。在PCS与ACS中,3个月的结局(数据可用性为70%)为死亡18.5%对20.5%,ATE:6.0%(0.7%-11.4%);改良Rankin量表评分0-1,分别为45.2%和37.5%,ATE:1.7%(-6.6%至3.2%);改良Rankin量表评分0–2,分别为61.3%和49.4%,ATE:2.4%(3.1%–7.9%)。荟萃分析显示,PCS与ACS相比SICH的相对风险为0.49(95%CI,0.32–0.75)。结论——PCS静脉溶栓后出血并发症的风险是ACS的一半,
更新日期:2020-02-24
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