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Objective To explore the association between post-stroke blood pressure and collaterals and functional outcome in acute ischemic stroke (AIS) patients with large vessel occlusion/stenosis.Methods Consecutive AIS patients with large vessel occlusion/stenosis who had symptom onset within 6 hours in Huashan Hospital from July 2011 to October 2017 were retrospectively recruited and enrolled.Collaterals were analyzed through CT perfusion imaging.And all the patients were followed up for 3 months.And the association between baseline blood pressure,collaterals and outcomes was analyzed using multivariate linear and Logistic models.A total of 126 patients were enrolled for multivariate Logistic and linear regression analysis.Results Multivariate Logistic regression analysis revealed that with every increment of 10 mmHg (1 mmHg =0.133 kPa) systolic blood pressure,the odds of poor functional outcome increased by 20％ (unadjusted OR =1.20,95％ CI 1.02-1.42,P =0.03).After adjusting for age and sex,the odds increased by 21％ (OR =1.21,95％ CI 1.01-1.46,P =0.04).However,no statistical significance was shown after multivariate adjustment (OR--1.02,95％ CI 0.99-1.05,P =0.06).Multivariate linear regression analysis demonstrated that diastolic blood pressure (DBP) was negatively associated with the volume of hypoperfused and severely hypoperfused lesion.With every increment of 10 mmHg DBP,the volume of delay time (DT) ＞ 6 s lesion downsized by 7.6 ml (unstandardized coefficient -7.56,95％ CI-14.89--0.24,P =0.04).The DT ＞6 s/DT ＞3 s ratio was also decreased with the elevation of DBP (unstandardized coefficient-0.03,95 ％ CI-0.06--0.01,P =0.01).Conclusions For AIS patients,though higher DBP seems to be associated with better collaterals,it may still relate with poor functional outcome.
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Objective To clarify the intravenous thrombolysis utilization of acute ischemic stroke patients in Huashan hospital,and to analyze the factors affecting thrombolytic therapy compliance.Methods The data from a prospective cohort were analyzed.Consecutive acute stroke and transient ischemic attack patients from Huashan Hospital emergency room were recruited in 2014.Eligible ischemic stroke patients were divided into two groups according to intravenous thrombolysis or not.Results Totally 220 patients from emergency room were assessed in 2014.Among eligible patients,43 patients refused intravenous thrombolysis,whereas 59 patients chose this therapy.After multiple analysis,age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were significantly different between the two groups (U =936.000,P =0.024;U =284.500,P ＜ 0.01;x2 =8.824,P =0.003;x2 =7.732,P=0.005;x2 =5.169,P=0.038;x2 =5.040,P=0.025).Patients with NIHSS score ＜7 tended to refuse thrombolysis therapy in the receiver operating characteristic curve analysis (sensitivity 0.93,specificity 0.71).From 2008 to 2014,244 cases were analyzed in the thrombolysis database.Compared with patients with higher baseline NIHSS score,intracranial hemorrhage rate (2.6％ vs 19.4％;x2 =12.466,P ＜0.01),7-day mortality rate (1.3％ vs 16.9％;x2 =12.308,P ＜0.01) and 3-month mortality rate (3.8％ vs 21.1％;x2 =11.993,P ＜0.01) were lower in patients whose baseline NIHSS score ＜ 7 (minor group).A higher rate of excellent outcome (3-month modified Rankin Scale score ≤ 1)was observed in minor group (78.2％ vs 38.0％;x2 =34.403,P ＜ 0.01).Conclusions Intravenous thrombolysis was performed in 54.6％ of eligible ischemic stroke patients.Age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were associated with patients' decision of thrombolysis.The effectiveness and safety of intravenous thrombolysis were promising for patients with mild stroke.
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Objective To determine factors associated with favorable clinical outcome in acute ischemic stroke patients who received intravenous thrombolysis.Methods Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA) between January 1,2008 and May 31,2013 were recruited.Favorable outcome was defined as modified Rankin scale (mRS) score ＜ 2 at 3 months.The baseline characteristics were compared by univariate and multivariate analysis.Results Of all the 148 patients studied,within the 4.5-hour time window,the rate of patients with a favorable outcome was 52.4％ (65/124),significantly better than those beyond the time window(20.8％ (5/24),x2 =8.048,P =0.005).Univariate analysis showed that age (U =2 146.000,P =0.025),TOAST classification (x2 =11.412,P =0.010),Oxfordshire Community Stroke Project (OCSP) classification (x2 =17.409,P =0.001),baseline blood glucose (U =1 446.500,P ＜ 0.01),baseline fibrinogen (U =1 689.000,P =0.038),admission NIHSS score (U =1 140.000,P ＜ 0.01),24-hour NIHSS score (U =458.000,P ＜0.01),and early symptom improvement (24-hour NIHSS score decreased ≥ 4 points,or down to 0 point;x2 =19.576,P ＜ 0.01) were the factors associated with clinical outcomes.Multivariate analysis revealed that age (odds ratio (OR) =0.943,95％ confidence interval (CI) 0.892-0.996,P =0.024),baseline fibrinogen (OR =0.448,95％ CI 0.208-0.963,P =0.040),baseline NIHSS score (OR =0.749,95％ CI 0.663-0.845,P ＜ 0.01),and early symptom improvement (OR =14.970,95％ CI 4.460-50.249,P ＜ 0.01) were independent predictors of clinical outcomes.Conclusions The effect of intravenous thrombolysis on clinical outcomes of acute ischemic stroke patients is time-dependent.Age,baseline NIHSS score,baseline fibrinogen level,and early symptom improvement are independent predictors of clinical outcomes after intravenous thrombolysis.
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Objective To assess the incidence of thrombocytopenia and abnormal coagulation,door to needle time (DNT),and safety in patients with ischemic stroke who receive intravenous thrombolytic treatment prior to the availability of blood platelet (PLT) and coagulation results.Methods Consecutive acute ischemic stroke (AIS) or transient ischemic attack patients within 12 hours of symptom onset who were admitted from January 2009 to March 2013 were retrospectively recruited.First laboratory reports in their medical charts were collected to assess the incidence of thrombocytopenia and abnormal coagulation.In the mean time,consecutive AIS patients who received intravenous thrombolysis at Huashan Hospital during the same period were retrospectively recruited.The thrombolytic procedures were further optimized since June 10.3760/cma.j.issn.1006-7876.2014.07.00626,2012.With informed consent,intravenous thrombolysis was initiated without PLT and coagulation results after certain previous history and medications were ruled out.Thrombolytic patients were divided into two groups based on the initiation of thrombolysis before or after PLT and coagulation results.Baseline demographic data,symptomatic intracerebral hemorrhage rates,mortality on the 7th day as well as functional outcome at 3 months were collected.DNT as well as efficacy and safety of thrombolysis therapy were compared between the two groups.Results Of 298 AIS patients within 12 hours of onset,8 had thrombocytopenia or abnormal coagulation.One hundred and twenty cases of intravenous thrombolysis patients were recruited.Waiting for PLT and coagulation results prolonged DNT than without waiting for them (90 min vs 59 min; U =870.000,P ＜0.01).There was no statistically significant difference in the rate of symptomatic intracerebral hemorrhage (sICH),early efficacy,7 d mortality and 3-month good outcome between two groups.Conclusions The incidence of thrombocytopenia and abnormal coagulation is low in AIS patients.Initiating intravenous thrombolysis prior to the availability of coagulation results can shorten DNT,while increased risks of sICH and 7 d mortality were not observed.