Treating ischaemic stroke with intravenous tPA beyond 4.5 hours under the guidance of a MRI DWI/T2WI mismatch was safe and effective  

作　　者：Qing-ke Bai Zhen-guo Zhao Lian-jun Lu Jian Shen Jian-ying Zhang Hai-jing Sui Xiu-hai Xie Juan Chen Juan Yang Cui-rong Chen 

机构地区：[1]Department of Neurology,Pudong People’s Hospital,Shanghai,China [2]Department of Radiology,The Affiliated Pudong People’s Hospital of Shanghai University of Medicine&Health Sciences,Shanghai,China

出　　处：《Stroke & Vascular Neurology》2019年第1期8-13,共6页卒中与血管神经病学（英文）

基　　金：Funded by Key Discipline Group Construction Project of Pudong Health Bureau of Shanghai(Grant No.PWZxq2017-02);by The Featured Clinical Discipline Project of Shanghai Pudong(Grant No.PWYst2018-01).

摘　　要：Purpose Clinical trials have provided evidence that treating patients with acute ischaemic stroke(AIS)beyond 4.5 hours was feasible.Among them using MRI diffusion-weighted imaging/fluid attenuation inversion response(DWI/FLAIR)mismatch to guide intravenous tissue plasminogen activator(tPA)was successful.Our study explored the outcome and safety of using DWI/T2-weighted imaging(T2WI)mismatch to guide intravenous tPA therapy for patients with AIS between 4.5 hours and 12 hours of onset.Method This was a retrospective study.Records of 1462 AIS patients with the time of onset of<12 hours were reviewed.Those had MRI rapid sequence study and had hyperintense signal on DWI but normal T2WI and received intravenous tPA up to 12 hours of onset were included in the analysis.Their demographics,risk factors,post-tPA complications,National Institutes of Health Stroke Scale(NIHSS)scores and outcome were recorded and analyse.χ2 was used to compare the intergroup variables.SAS was used to perform statistical calculation.A p<0.05 was considered statistically significant.results Of 1462 identified,601(41%)patients were entered into the final analysis.Among them,327(54%)had intravenous tPA within 4.5 hours of onset and 274(46%)were treated between 4.5-12 hours.After intravenous tPA,426 cases(71%)had>4 pints of improvement on NIHSS score within 24 hours.Postintravenous tPA,32(5.32%)cases had haemorrhagic transformation.26(4.33%)were asymptomatic ICH and 4(0.67%)died.At 90 days,523(87%)achieved a modified Rankin scale of 0-2.Conclusion Using MRI DWI/T2WI mismatch to identify patients with AIS for intravenous tPA between 4.5 hours and 12 hours was safe and effective.The outcome was similar to those used DWI/PWI or DWI/FLAIR mismatch as the screening tool.However,obtaining DWI/T2WI was faster and avoided the need of contrast material.

关 键 词：T2WI INTRAVENOUS analysis. 

分 类 号：R74[医药卫生—神经病学与精神病学]