경증 급성 뇌경색 환자에서 정맥내혈전용해술 및 혈관내혈전제거술
Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Ischemic Stroke with Minor Symptom
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
More than 50% of all patients with ischemic stroke initially present with mild symptoms. Despite the mild clinical presentation, a high percentage of these patients develop stroke progression with consequent disability, recurrent stroke, or death at follow-up. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours has been proven to be an effective treatment for acute ischemic stroke, but the risk-benefit ratio of this therapeutic approach remains still unclear in patients with mild stroke. Many patients with mild stroke are frequently excluded from thrombolysis. Large artery occlusion is an important predictor of early neurological deterioration or poor outcomes in patients with mild ischemic stroke. However, current guidelines do not recommend endovascular thrombectomy in patients with National Institutes of Health Stroke Scale score of <6 points. Some previous retrospective cohort studies have reported that endovascular thrombectomy showed promising results in cases of acute mild ischemic stroke with large vessel occlusion. Treatment decisions in patients with mild ischemic stroke should be individualized depending on clinical and radiological features. In this review, we discuss the prognosis of mild strokes, efficacy of intravenous thrombolysis and endovascular thrombectomy, and the role of neurovascular imaging in treatment decision making in this patient population.
Abstract
More than 50% of all patients with ischemic stroke initially present with mild symptoms. Despite the mild clinical presentation, a high percentage of these patients develop stroke progression with consequent disability, recurrent stroke, or death at follow-up. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours has been proven to be an effective treatment for acute ischemic stroke, but the risk-benefit ratio of this therapeutic approach remains still unclear in patients with mild stroke. Many patients with mild stroke are frequently excluded from thrombolysis. Large artery occlusion is an important predictor of early neurological deterioration or poor outcomes in patients with mild ischemic stroke. However, current guidelines do not recommend endovascular thrombectomy in patients with National Institutes of Health Stroke Scale score of <6 points. Some previous retrospective cohort studies have reported that endovascular thrombectomy showed promising results in cases of acute mild ischemic stroke with large vessel occlusion. Treatment decisions in patients with mild ischemic stroke should be individualized depending on clinical and radiological features. In this review, we discuss the prognosis of mild strokes, efficacy of intravenous thrombolysis and endovascular thrombectomy, and the role of neurovascular imaging in treatment decision making in this patient population.
참고문헌 (53)
- 김범준, "Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea", 대한뇌졸중영문학회지, 17(1), pp.38~53 (2015), 대한뇌졸중학회
- Reeves M, "Distribution of National Institutes of Health Stroke Scale in the Cincinnati", Northern Kentucky stroke study, 2013, pp.44, 3211~3213
- Jun Yup Kim, "Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society", 대한뇌졸중영문학회지, 21(1), pp.42~59 (2019), 대한뇌졸중학회[DOI]
- Laurencin C, "Thrombolysis for acute minor stroke: outcome and barriers to management. Results from the RESUVAL stroke network", Cerebrovasc Dis, 40, pp.3~9 (2015)
- Spokoyny I, "Defining mild stroke: outcomes analysis of treated and untreated mild stroke patients", J Stroke Cerebrovasc Dis, 24, pp.1276~1281 (2015)
- Khatri P, "Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke", Stroke, 43, pp.560~562 (2012)
- Yu AY, "Should minor stroke patients be thrombolyzed? A focused review and future directions", Int J Stroke, 10, pp.292~297 (2015)
- Choi JC, "Utility of items of baseline National Institutes of Health Stroke Scale as predictors of functional outcomes at three months after mild ischemic stroke", J Stroke Cerebrovasc Dis, 26, pp.1306~1313 (2017)
- Fischer U, "What is a minor stroke?", Stroke, 41, pp.661~666 (2010)
- Wendt M, "Preclusion of ischemic stroke patients from intravenous tissue plasminogen activator treatment for mild symptoms should not be based on low National Institutes of Health Stroke Scale scores", J Stroke Cerebrovasc Dis, 22, pp.550~553 (2013)
- Khatri P, "Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial", JAMA, 320, pp.156~166 (2018)
- Sato S, "Factors associated with unfavorable outcome in minor ischemic stroke", Neurology, 83, pp.174~181 (2014)
- Kim JT, "Proximal arterial occlusion in acute ischemic stroke with low NIHSS scores should not be considered as mild stroke", PLoS One, 8, pp.e70996~ (2013)
- Coutts SB, "Computed tomography and computed tomography angiography findings predict functional impairment in patients with minor stroke and transient ischaemic attack", Int J Stroke, 4, pp.448~453 (2009)
- Lin C, "Infarct location is associated with quality of life after mild ischemic stroke", Int J Stroke, 13, pp.824~831 (2018)
- Kim DH, "Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke", BMC Neurol, 18, pp.30~ (2018)
- Urra X, "The outcome of patients with mild stroke improves after treatment with systemic thrombolysis", PLoS One, 8, pp.e59420~ (2013)
- Mishra NK, "Thrombolysis is associated with consistent functional improvement across baseline stroke severity: a comparison of outcomes in patients from the virtual international stroke trials archive (VISTA)", Stroke, 41, pp.2612~2617 (2010)
- Greisenegger S, "Thrombolysis in patients with mild stroke: results from the Austrian stroke unit registry", Stroke, 45, pp.765~769 (2014)
- Choi JC, "Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke", J Am Heart Assoc, 4, pp.e001306~ (2015)
- Mair G, "Arterial obstruction on computed tomographic or magnetic resonance angiography and response to intravenous thrombolytics in ischemic stroke", Stroke, 48, pp.353~360 (2017)
- Heldner MR, "Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients", J Neurol Neurosurg Psychiatry, 86, pp.755~760 (2015)
- Zhou Z, "Thrombolysis outcomes in acute ischemic stroke by fluid-attenuated inversion recovery hyperintense arteries", Stroke, 51, pp.2240~2243 (2020)
- Emberson J, "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials", Lancet, 384, pp.1929~1935 (2014)
- Asdaghi N, "Predictors of thrombolysis administration in mild stroke: florida-puerto rico collaboration to reduce stroke disparities", Stroke, 49, pp.638~645 (2018)
- Wang XH, "Antiplatelet vs. rt-PA for acute mild ischemic stroke: a prospective, random, and open label multi-center study", Int J Stroke, 14, pp.658~663 (2019)
- Powers WJ, "2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2018, pp.49, e46~e110
- Ahmed N, "Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018", Eur Stroke J, 4, pp.307~317 (2019)
- Levine SR, "To treat or not to treat?", Stroke, 49, pp.1933~1938 (2018)
- Seners P, "Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications", J Neurol Neurosurg Psychiatry, 86, pp.87~94 (2015)
- Mori M, "Early neurological deterioration within 24 hours after intravenous rt-PA therapy for stroke patients: the stroke acute management with urgent risk factor assessment and improvement rt-PA registry", Cerebrovasc Dis, 34, pp.140~146 (2012)
- Lee VH, "Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits", J Neurointerv Surg, 12, pp.1085~1087 (2020)
- Romano JG, "Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the get with the guidelines-stroke registry", JAMA Neurol, 72, pp.423~431 (2015)
- Strbian D, "Intravenous thrombolysis for acute ischemic stroke patients presenting with mild symptoms", Int J Stroke, 8, pp.293~299 (2013)
- Majidi S, "MRI-based thrombolytic therapy in patients with acute ischemic stroke presenting with a low NIHSS", Neurology, 93, pp.e1507~e1513 (2019)
- Coutts SB, "Tenecteplase-tissue-type plasminogen activator evaluation for minor ischemic stroke with proven occlusion", Stroke, 46, pp.769~774 (2015)
- Seners P, "Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors", Stroke, 45, pp.2004~2009 (2014)
- Coutts SB, "What causes disability after transient ischemic attack and minor stroke?: results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) study", Stroke, 43, pp.3018~3022 (2012)
- Heldner MR, "National Institutes of Health Stroke Scale score and vessel occlusion in 2152 patients with acute ischemic stroke", Stroke, 44, pp.1153~1157 (2013)
- Haussen DC, "Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts", J Neurointerv Surg, 10, pp.325~329 (2018)
- Nagel S, "Mechanical thrombectomy in patients with milder strokes and large vessel occlusions", Stroke, 49, pp.2391~2397 (2018)
- Sarraj A, "Endovascular thrombectomy for mild strokes: how low should we go?", Stroke, 49, pp.2398~2405 (2018)
- Wolman DN, "Endovascular versus medical therapy for large-vessel anterior occlusive stroke presenting with mild symptoms", Int J Stroke, 15, pp.324~331 (2020)
- Goyal N, "Medical management vs mechanical thrombectomy for mild strokes: an international multicenter study and systematic review and meta-analysis", JAMA Neurol, 77, pp.16~24 (2019)
- Saleem Y, "Acute neurological deterioration in large vessel occlusions and mild symptoms managed medically", Stroke, 51, pp.1428~1434 (2020)
- Dargazanli C, "Mechanical thrombectomy for minor and mild stroke patients harboring large vessel occlusion in the anterior circulation: a multicenter cohort study", Stroke, 48, pp.3274~3281 (2017)
- Goyal M, "Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
- Keun-Sik Hong, "Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke", 대한뇌졸중영문학회지, 18(1), pp.102~113 (2016), 대한뇌졸중학회
- Ospel JM, "Endovascular treatment decision-making in acute ischemic stroke patients with large vessel occlusion and low National Institutes of Health Stroke Scale: insights from unmask EVT, an international multidisciplinary survey", Neuroradiology, 62, pp.715~721 (2020)
- Kimmel ER, "Absence of collaterals is associated with larger infarct volume and worse outcome in patients with large vessel occlusion and mild symptoms", J Stroke Cerebrovasc Dis, 28, pp.1987~1992 (2019)
- Shang XJ, "Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials", BMC Neurol, 19, pp.150~ (2019)
- Kim DH, "Prominent FLAIR vascular hyperintensity is a predictor of unfavorable outcomes in non-thrombolysed ischemic stroke patients with mild symptoms and large artery occlusion", Front Neurol, 10, pp.722~ (2019)
- Seners P, "Bridging therapy or IV thrombolysis in minor stroke with large vessel occlusion", Ann Neurol, 88, pp.160~169 (2020)
