Background

Early thrombolysis for acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) is associated with better clinical outcome. This is thought to be due to greater tissue salvage with earlier recanalization. We explored whether ultra-early administration of intravenous tissue plasminogen activator (IV tPA) within 60 min (Golden Hour) of symptom onset for AIS due to ELVO is associated with a higher rate of recanalization.

Methods

We performed a retrospective analysis of recanalization rates and clinical outcomes in patients with AIS due to ELVO treated with IV tPA, comparing patients who received IV tPA within 60 min of stroke symptom onset with those treated beyond 60 min.

Results

Between January 2013 and December 2016, 158 patients with AIS due to ELVO were treated with IV tPA. Of these, 25 (15.8%) patients received IV tPA within 60 min of stroke symptom onset, while the remaining 133 (84.2%) patients received IV tPA beyond 60 min. The ultra-early treatment group was found to have a higher rate of complete recanalization (28.0% vs 6.8%, 95% CI 1.78–16.63), better chance of early neurological improvement (76.0% vs 50.4%, 95% CI 1.16–8.65), favorable clinical outcomes (mRS ≤ 2 or return to premorbid mRS) (65.0% vs 36.8%, 95% CI 1.42–9.34), and lower mortality (5% vs 31.1%, 95% CI 0.01–0.74) at 90-day follow-up compared to the later treatment group.

Conclusion

Our data suggest that ultra-early administration of IV tPA significantly improves recanalization rates and clinical outcomes in patients with AIS due to ELVO.

中文翻译：

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在紧急大血管闭塞性卒中的黄金时段给予 IV tPA 可提高再通率和临床结果

背景

由于紧急大血管闭塞 (ELVO) 引起的急性缺血性卒中 (AIS) 的早期溶栓与更好的临床结果相关。这被认为是由于早期再通可以更好地挽救组织。我们探讨了在 ELVO 引起的 AIS 症状发作后 60 分钟（黄金时间）内超早期静脉注射组织纤溶酶原激活剂 (IV tPA) 是否与更高的再通率相关。

方法

我们对接受 IV tPA 治疗的 ELVO 所致 AIS 患者的再通率和临床结果进行了回顾性分析，比较了在卒中症状发作后 60 分钟内接受 IV tPA 的患者与治疗超过 60 分钟的患者。

结果

2013 年 1 月至 2016 年 12 月期间，158 名 ELVO 导致的 AIS 患者接受了 IV tPA 治疗。其中，25 名（15.8%）患者在卒中症状出现后 60 分钟内接受了静脉 tPA，而其余 133 名（84.2%）患者在 60 分钟后接受了静脉 tPA。超早期治疗组的完全再通率更高（28.0% vs 6.8%，95% CI 1.78-16.63），早期神经功能改善的机会更大（76.0% vs 50.4%，95% CI 1.16-8.65） )、良好的临床结果（mRS ≤ 2 或恢复到病前 mRS）（65.0% 对 36.8%，95% CI 1.42-9.34），死亡率较低（5% 对 31.1%，95% CI 0.01-0.74）在 90-与较晚的治疗组进行一天的随访。

结论

我们的数据表明，IV tPA 的超早期给药显着提高了 ELVO 引起的 AIS 患者的再通率和临床结果。