多学科团队协作模式在MRI指导下脑卒中静脉溶栓诊疗中的应用

目的探讨多学科团队协助模式在脑卒中静脉溶栓诊疗中的应用,为急性脑梗死的诊疗提供参考。方法选取2017年1～12月行rt-PA静脉溶栓治疗的113例急性缺血性脑卒中患者为对照组,另选取流程改进后(2018年1～12月)行rt-PA静脉溶栓治疗的120例急性缺血性脑卒中患者为观察组,分析就诊至完善影像学检查时间、就诊至溶栓开始时间(DNT)时间、静脉溶栓治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、Barthel指数变化、有无出血并发症等影响因素。结果观察组CT至完成头颅MRI时间、MR至静脉溶栓时间、DNT时间均较对照组缩短(P 0. 05);两组溶栓后24 h NIHSS评分改善差异无统计学意义(P 0. 05),观察组溶栓后7、30和90 d NIHSS评分、mRS评分、Barthel指数改善均优于对照组(P 0. 05);静脉溶栓过程中牙龈出血及症状性颅内出血两组比较差异无统计学意义(P 0. 05)。结论多学科团队协助模式可有效缩短急性缺血性脑卒中患者的就诊时间、检查时间及DNT时间,促进患者的神经功能恢复。     

SWI皮质血管征对大脑中动脉脑梗死rt-PA静脉溶栓预后的评估

目的探讨SWI皮质血管征和大脑中动脉脑梗死rt-PA静脉溶栓预后的关系。方法选取河南省人民医院258例急性大脑中动脉脑梗死静脉溶栓住院患者,采用3. 0T MRI在溶栓前行DWI、SWI和PWI序列检查,溶栓24 h后给予抗血小板聚集、辅助用药和持续康复训练,计算3 m后改良的Rankin量表(Modified Rankin Scale,mRS)。根据mRS评分,分为预后良好组和预后不良组。首先SDM(SWI-DWI)和PDM(PWI-DWI)进行差异性比较;然后影响预后程度有关的因素进行Logistic回归分析,对有差异性因素进行回归参数的估计;最后,预后程度和溶栓前SDM/SWI比值进行两样本定量资料的比较,并行关联性分析。结果 SDM和PDM比较(P 0. 05),差异无统计学意义。年龄、治疗时间窗、卒中的严重程度和复发性卒中均和预后程度有关联,治疗时间窗(OR=8. 381)复发性卒中(OR=6. 194),卒中的严重程度(OR=3. 234)和年龄(OR=2. 682)。预后程度两组间溶栓前SDM/SWI比值差异有统计学意义(P 0. 05);两变量行Spearman线性相关分析(r=0. 683,P 0. 05)。结论 SWI皮质血管征可用于大脑中动脉脑梗死rt-PA静脉溶栓预后的评估,SDM/SWI比值和预后呈正相关。     

Solitaire支架机械取栓治疗急性缺血性卒中疗效分析

目的探讨Solitaire支架机械取栓术治疗急性缺血性卒中的疗效。方法回顾分析使用Solitaire支架取栓或静脉溶栓的急性缺血性卒中患者临床资料,分析患者治疗后再通情况,比较治疗前后NIHSS评分差异及随访3个月时mRS情况。结果 18例机械取栓患者均获得再通,17例完全再通,其中1例患者取栓术后局部狭窄行支架成形术;1例取栓后大脑前动脉A2段不显影。术后复查头颅CT平扫,1例为术区少量出血;1例患者出现大面积脑出血,出血后死亡;1例患者出现大面积脑梗死伴出血后死亡。患者术前NIHSS评分18.0(10.8,20.2)分,术后1周NIHSS评分9.0(5.0,14.2);3个月后随访mRS评分2分9例。16例静脉溶栓患者术前NIHSS评分16.0(10.0,20.0),术后1周NIHSS评分10.0(8.0,14.0),3个月后随访mRS评分2分5例。术前(Z=-0.434,P=0.664)和术后(Z=-0.313,P=0.754)的NIHSS评分在两组之间差异无统计学意义,但机械取栓组的NIHSS评分降低值大于静脉溶栓组(6.5 vs 6.0),差异有统计学意义(Z=-2.090,P=0.037);机械取栓组患者治疗后出院3个月mRS评分1.5(1.0,2.3)低于静脉溶栓组mRS评分4.5(1.0,4.8),并差异有统计学意义(Z=-2.015,P=0.044)。结论 Solitaire支架取栓治疗急性缺血性卒中再通率高,可以改善预后,是急性缺血性卒中的可选治疗方式。     

轻症脑梗死rt-PA静脉溶栓的疗效及安全性观察

目的观察静脉注射阿替普酶(rt-PA)治疗急性轻症脑梗死患者的临床疗效及安全性。方法采用前瞻性研究方法,收集110例起病4.5h内、美国国立卫生研究院卒中量表(NIHSS)评分≤7分的轻症脑梗死患者的临床资料,其中试验组53例接受rt-PA静脉溶栓治疗,对照组57例接受常规治疗,通过分析患者基线资料及溶栓后24h、7dNIHSS和改良Rankin量表(mRS)评分、90d的mRS评分及治疗期间的颅内出血转化、其他部位出血、药物过敏、死亡等不良事件,评估试验治疗方案的有效性和安全性。结果在2组患者人口学特征、影像学特点、实验室检查、神经功能评分等基线资料中,既往脑出血史对照组显著高于试验组,差异有统计学意义(P0.05),而其他基线资料2组间差异无统计学意义(P0.05)。24h后试验组NIHSS、mRS评分均显著低于对照组,差异有统计学意义(P0.05);7d后试验组NIHSS、mRS评分同样低于对照组,差异有统计学意义(P0.05);90d时试验组mRS为0分、0~1分的比例显著高于对照组,差异有统计学意义(P0.05)。安全性方面2组中轻型出血转化各1例,无过敏及死亡病例,差异无统计学意义(P0.05),但颅外少量局限性出血等不良反应,试验组显著高于对照组,差异有统计学意义(P0.05)。结论轻症脑梗死接受rt-PA静脉溶栓有效和相对安全。     

PWI指导最后正常时间>4.5 h醒后脑卒中静脉溶栓临床观察

目的探讨磁共振灌注成像(PWI)指导最后正常时间4. 5 h醒后脑卒中静脉溶栓的安全性及有效性。方法选取最后正常时间4. 5 h醒后脑卒中患者,经患者或家属签署知情同意书后行磁共振检查,对存在缺血半暗带且同意静脉溶栓治疗的36例患者给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗(WUS组);同时将发病时间4. 5 h的36例急性脑梗死患者作为溶栓对照组。记录溶栓前、溶栓后2 h、24 h、7 d、出院前NIHSS评分及溶栓后3个月mRS评分并进行比较,复查头颅CT,监测并发症。结果 2组溶栓后各时间段NIHSS评分均呈下降趋势,WUS组溶栓后各时间段NIHSS评分与治疗前相比均有明显改善(P0. 05),而对照组NIHSS评分于溶栓后7 d、出院前明显降低(P0. 05)。2组溶栓后3个月mRS评分(0～2)比较差异无统计学意义(P0. 05)。2组溶栓后不良事件发生情况比较差异无统计学意义(P0. 05)。结论对于发病时间4. 5 h的醒后脑卒中患者,磁共振灌注成像检查指导静脉溶栓治疗安全有效。     

静脉溶栓与桥接治疗颅内大动脉闭塞性脑梗死的临床疗效与安全性

目的探讨急性颅内大动脉闭塞性脑梗死患者静脉溶栓及桥接治疗(静脉溶栓联合机械取栓)的临床疗效和安全性。方法选取我院2016年7月至2017年7月收治的急性大血管闭塞性缺血性脑卒中患者65例,其中30例接受静脉溶栓者为溶栓组,35例接受桥接治疗者为取栓组,通过比较患者基线资料及治疗后24 h、7 d的NHISS和早期预后良好率、血管再通率、90 d的mRS评分,同时对比治疗期间的颅内出血转化、其他部位出血、血管再闭塞、临床死亡等不良事件,评估两种治疗方案的有效性和安全性。结果与治疗前比较,两组治疗后24 h和7 d的NIHSS评分均明显降低(均P 0. 05);治疗后24 h及7 d的NIHSS评分取栓组均明显低于溶栓组(均P 0. 05);治疗后24 h、7 d的早期预后良好率取栓组(51. 4%、68. 6%)均明显高于溶栓组(26. 7%、40. 0%)(均P 0. 05);取栓组血管再通率(82. 9%)明显高于静脉溶栓组(36. 7%)(P 0. 05);治疗后90 d的远期预后良好率(mRS≤2)取栓组(71. 4%)明显高于溶栓组(43. 3%)(P 0. 05);两组不良反应包括脑出血转化、其他部位出血、血管再闭塞、药物过敏、临床死亡等发生率,溶栓组为40. 0%,取栓组为42. 8%,两组比较差异无统计学意义(P 0. 05)。结论桥接治疗急性缺血性大动脉性脑卒中效果较好,且安全性与静脉溶栓治疗比较差异无显著性。     

磁共振磁敏感加权成像在急性缺血性脑卒中溶栓治疗中的评估作用

目的：运用磁共振磁敏感加权成像(SWI)检查急性缺血性卒中患者溶栓时间窗内溶栓治疗前后静脉低信号及微出血情况,观察患者静脉溶栓治疗的预后及安全性,以指导个性化溶栓治疗.方法急性缺血性卒中患者行多模磁共振检查,根据 SWI 检测结果分为静脉对称组和静脉不对称组,患者接受重组组织型纤溶酶原激活剂(rt－PA)静脉溶栓治疗后复查多模磁共振.观察对比两组间疗效、安全性及预后情况.结果共纳入60例患者,其中静脉对称组17例,静脉不对称组43例.两组治疗前、治疗后1 h 及24 h 的美国国立卫生院卒中量表(NIHSS)评分分别为(11．9±3．8),(7．3±4．5),(7．1±5．2)分和(12．4±4．2),(8．2±4．3),(7．9±4．8)分,治疗后两组间比较差异有统计学意义(P ＜0.01).90 d死亡率均为0.静脉对称组微出血灶数目、微出血级别及症状性脑出血发生率低于静脉不对称组,但差异无统计学意义(P ＞0．05).两组90 d 神经功能改善率为分别为70．2％和58．1％,静脉对称组预后优于静脉不对称组,差异有统计学意义(P ＜0．05).结论 SWI 静脉低信号可以作为评价低灌注程度、溶栓预后效果及溶栓后出血的指标,指导个体化溶栓治疗.     

多模式MR I指导下超时间窗进展性脑梗死静脉溶栓临床研究

目的 探讨超时间窗进展性脑梗死低剂量阿替普酶静脉溶栓疗效及安全性。方法 多模式MRI指导下,选取焦作煤业集团中央医院2016-01—2018-11收治超时间窗(发病6～12h)进展性脑梗死患者70例为研究对象,随机分为溶栓组35例及未溶栓组35例,未溶栓组给予常规治疗,溶栓组在常规治疗基础上低剂量(0.6mg/kg)阿替普酶静脉溶栓。观察2组患者1d、7d、14dNIHSS评分变化、90d良好预后率(mRS≤2)及症状性出血发生率。结果 溶栓组NIHSS评分下降明显,与未溶栓组比较,差异有统计学意义(P0.05);溶栓组90d良好预后患者多于未溶栓组,差异有统计学意义(P0.05);症状性出血发生率比较,2组差异无统计学意义(P0.05)。结论 多模式MRI指导下,严格筛选超时间窗进展性脑梗死患者低剂量阿替普酶静脉溶栓,可获得良好临床效果,改善短期预后,症状性出血发生率无明显增加。     

机械取栓与静脉溶栓治疗急性脑梗死临床分析

目的分析机械取栓、静脉溶栓及保守治疗急性脑梗死的临床效果、安全性及预后。方法选择2016-06—2018-03安阳市人民医院治疗的101例急性脑梗死患者为研究对象,根据不同治疗方案分为A组(机械取栓组,35例)、B组(静脉溶栓组,34例)及C组(保守治疗组,32例)。使用美国国立卫生研究院卒中量表(NIHSS)评分及90d改良Rankin量表(mRS),比较各组治疗前、治疗后即刻、治疗后24h、治疗后1周和2周的有效性及安全性。结果治疗后2周,3组总体NIHSS评分显著下降(P0.05),A、B组NIHSS评分明显低于C组,A组明显低于B组,差异均有统计学意义(P0.05)。治疗后1周,3组颅内出血率、消化道出血率、病死率差异无统计学意义(P0.05)。治疗后3个月,3组mRS≤2分者所占比例差异有统计学意义(P0.05)。结论机械取栓与静脉溶栓对大动脉急性脑梗死均有良好的临床疗效,且机械取栓较静脉溶栓安全性更高,远期预后良好。     

心源性脑栓塞患者尿激酶静脉溶栓的疗效及安全性

目的探讨心源性脑栓塞患者尿激酶静脉溶栓的疗效及安全性。方法 64例急性缺血性卒中患者在发病6h内接受静脉溶栓治疗,根据患者既往史及入院时心电图检查结果将患者分为心房颤动组(22例)和非心房颤动组(42例),所有患者溶栓前行美国国立卫生研究院卒中量表(NIHSS)评分,溶栓后3个月行改良Rakin量表(mRS)评分。结果心房颤动组和非心房颤动组溶栓后3个月mRS评分0~1分患者比例差异无统计学意义(P0.05),心房颤动组和非心房颤动组症状性颅内出血比例差异无统计学意义(P0.05)。结论心房颤动不影响急性缺血性卒中患者静脉溶栓治疗的远期疗效,心房颤动患者行静脉溶栓不增加症状性颅内出血风险。     

A one-to-one telestroke network: the first Italian study of a web-based telemedicine system for thrombolysis delivery and patient monitoring

Over 10 years after European approval, thrombolysis is still limited by a restricted time window and non-optimal territorial coverage. Implementation of telestroke can give a growing number of patients access to treatment. We hereby present the first Italian telemedicine study applied to both the acute and the monitoring phase of stroke care. From January 2011 to December 2013, we tested a web-based, drip, and treat interaction model, connecting the cerebrovascular specialist of one hub center to the Emergency Department of a Spoke center. We then compared thrombolysis delivered using the telestroke model with thrombolysis provided at the Hub Stroke Unit at the time when the telemedicine program was activated. Telethrombolysis data were then compared with data from the two main international telestroke projects (TEMPiS and REACH), and other European telestroke studies performed at the time of writing. We collected a total of 131 thrombolysis procedures (25 telethrombolysis and 106 thrombolysis patients at the Stroke Unit). Statistical analysis with the t test yielded no statistically significant differences between the two populations in door-to-scan, door-to-needle (DTN), and onset-to-treatment times (OTT). Our OTT and DTN pathway times were longer than the TEMPiS and REACH studies but comparable with other European telemedicine trials, despite different models of interaction and number of centers. Our study in a northeastern province of Italy confirms the potential of applying telemedicine to a cerebrovascular pathology.     

急诊启动急性缺血性脑卒中静脉内溶栓治疗对开始溶栓平均时间的影响及其安全性探讨

目的探索急性缺血性脑卒中(AIS)患者在神经内科急诊接受静脉内溶栓和传统收住至病房或卒中单元后接受静脉内溶栓对开始溶栓平均时间(DTN)的影响及其安全性。方法对2012年4月至2015年6月收治的176例AIS患者进行回顾性病例对照分析,比较急诊室启动溶栓组(94例)和病房启动溶栓组(82例)的DTN时间和安全性等指标,包括两组的治疗7 d时和治疗后3个月的病死率、溶栓后24 h症状性出血转化率等。结果两组基线特征差异无统计学意义(P0.05)。急诊溶栓组DTN时间(99.3±47.8)min显著短于病房溶栓组(118.8±53.2)min,P=0.014;治疗后24 h两组安全性比较,症状性颅内出血转化率差异无统计学意义(P0.05),治疗后7 d和3个月两组病死率差异无统计学意义(P0.05);两组溶栓治疗后7 d用美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分(m RS)和溶栓治疗3个月恢复良好(m RS2分)的比例差异无统计学意义(P0.05)。结论在急诊启动静脉内溶栓治疗AIS能明显缩短DTN,安全性与送入病房后再进行静脉内溶栓治疗差异无显著性,AIS的静脉内溶栓治疗应在急诊尽快启动,若急诊空间有限,溶栓和送入病房可同时进行(Drip-and-Ship)。     

高龄急性脑梗死患者阿替普酶静脉溶栓有效性、安全性及预后影响因素分析

目的 探讨高龄急性脑梗死患者接受阿替普酶静脉溶栓治疗有效性、安全性和临床预后的影响 因素。 方法 前瞻性连续纳入江苏省苏北人民医院2016年9月-2018年9月收治入院进行阿替普酶静脉溶 栓治疗的急性脑梗死患者，按照年龄将患者分为年龄≥80岁组和年龄＜80岁组。比较两组患者入院 时、溶栓24 h NIHSS评分，6个月mRS评分及死亡率，观察两组溶栓相关出血转化、症状性颅内出血及 肺部感染的发生情况。应用多因素Logistic回归分析观察所有患者静脉溶栓预后的独立影响因素。 结果 最终共纳入患者119例，男性69例（58.0%），年龄范围46～94岁，平均70.12±10.55岁，入院 NIHSS评分4～38分。其中年龄≥80岁患者29例，年龄＜80岁患者90例。静脉溶栓后，两组患者溶栓 24 h NIHSS评分较入院时均明显降低（均P＜0.05），两组治疗24 h NIHSS评分比较差异无统计学意义； 两组的出血转化、症状性颅内出血、肺部感染、6个月预后良好及死亡率比较，差异均无统计学意义。 多因素Logistic回归分析显示，入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是脑梗死静脉溶 栓6个月预后的独立危险因素（P＜0.05），高龄不是影响预后的因素（P＞0.05）。 结论 高龄急性脑梗死患者静脉溶栓治疗安全有效，未增加颅内出血转化风险、死亡率及不良预 后。入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是急性脑梗死患者静脉溶栓6个月预后不良 的独立危险因素。     

高龄急性轻型缺血性卒中早期阿替普酶静脉溶栓疗效观察

目的 探讨高龄轻型缺血性卒中3 h内行阿替普酶静脉溶栓治疗的疗效及安全性。 方法 将我院2015年10月-2017年10月连续收治入院的发病3 h内48例高龄急性轻型缺血性卒中患者 随机分为阿替普酶静脉溶栓组24例和未溶栓组24例。比较两组患者入院时的一般情况,基线美国 国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NHISS）评分,治疗24 h后颅内出 血转化率,治疗后90 d改良Rankin量表（modified Rankin Scale,mRS）评分及90 d病死率。 结果 阿替普酶静脉溶栓组和未溶栓组患者一般临床资料、基线NIHSS评分比较,差异无统计学意 义。阿替普酶静脉溶栓组和未溶栓组治疗24 h后颅内出血转化率分别为4.17%和0（P =1.000）,两组 90 d病死率均为4.17%（P =1.000）,阿替普酶静脉溶栓组及未溶栓组90 d mRS评分为0～2分的比率 分别为83.33%和54.17%（P =0.029）。 结论 早期阿替普酶静脉溶栓治疗高龄急性轻型缺血性卒中不增加急性期颅内出血转化的风险, 可以改善高龄轻型缺血性卒中患者预后,不增加病死率。     

高龄急性脑梗死患者阿替普酶静脉溶栓有效性、安全性及预后影响因素分析

目的 探讨高龄急性脑梗死患者接受阿替普酶静脉溶栓治疗有效性、安全性和临床预后的影响
因素。
方法 前瞻性连续纳入江苏省苏北人民医院2016年9月-2018年9月收治入院进行阿替普酶静脉溶
栓治疗的急性脑梗死患者，按照年龄将患者分为年龄≥80岁组和年龄＜80岁组。比较两组患者入院
时、溶栓24 h NIHSS评分，6个月mRS评分及死亡率，观察两组溶栓相关出血转化、症状性颅内出血及
肺部感染的发生情况。应用多因素Logistic回归分析观察所有患者静脉溶栓预后的独立影响因素。
结果 最终共纳入患者119例，男性69例（58.0%），年龄范围46～94岁，平均70.12±10.55岁，入院
NIHSS评分4～38分。其中年龄≥80岁患者29例，年龄＜80岁患者90例。静脉溶栓后，两组患者溶栓
24 h NIHSS评分较入院时均明显降低（均P＜0.05），两组治疗24 h NIHSS评分比较差异无统计学意义；
两组的出血转化、症状性颅内出血、肺部感染、6个月预后良好及死亡率比较，差异均无统计学意义。
多因素Logistic回归分析显示，入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是脑梗死静脉溶
栓6个月预后的独立危险因素（P＜0.05），高龄不是影响预后的因素（P＞0.05）。
结论 高龄急性脑梗死患者静脉溶栓治疗安全有效，未增加颅内出血转化风险、死亡率及不良预
后。入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是急性脑梗死患者静脉溶栓6个月预后不良
的独立危险因素。     

Conservative medical treatment and intravenous thrombolysis in acute stroke from carotid T occlusion

BACKGROUND: We aimed to analyse the course of early recanalization and corresponding functional outcome in patients with an acute occlusion of the carotid T who were treated conservatively or underwent intravenous thrombolysis. METHODS: Forty-two patients with an acute occlusion of the carotid T within 6 h were recruited from consecutive admissions to a neurological department participating in the Duplex Sonography in Acute Stroke study. All patients underwent a standardized admission and follow-up procedure. Colour-coded duplex sonography was performed on admission, 30 min after thrombolysis, and at 6 and 24 h after onset of symptoms. Recanalization of the carotid T was classified as complete, partial and absent. Functional outcome was rated with the modified Rankin scale (mRS) at 3 months as favourable (mRS 0-2) or poor (mRS 3-6). RESULTS: Within 6 h, complete or partial recanalization occurred in 1 of 27 patients treated conservatively and in 6 of 15 thrombolysed patients. Intravenous thrombolysis predicted early recanalization also after adjustment for age, sex, cardioembolic stroke aetiology and time to treatment (adjusted odds ratio, OR, 39.7; 95% confidence interval, CI, 2.0-801.7; p = 0.016). An early recanalization was the only selected predictor of a favourable outcome (OR, 13.6; 95% CI, 1.0-179.0; p = 0.047) at regression analysis, and was achieved in 3 thrombolysed patients but in none with conservative medical treatment. CONCLUSIONS: In patients treated conservatively, functional outcome is poor and early recanalization rarely occurs. The latter can be achieved by intravenous thrombolysis with a rate comparable to that found at an intra-arterial approach without major intracranial bleeding complications. Early recanalization is associated with a better functional outcome.     

The First 10 Thrombolysis for Acute Ischemic Stroke in Lao People's Democratic Republic under Teleconsultation from Thailand

Background: Acute ischemic stroke patients in Lao People's Democratic Republic (Lao PDR) are unable to access the intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) due to various reasons. Aims: This study aimed to evaluate the feasibility and safety of thrombolytic therapy administration at Mittaphab Hospital, Lao PDR under the international telestroke consultation system from King Chulalongkorn Memorial Hospital, Thailand. Methods: Acute ischemic stroke patients who presented at Mittaphab Hospital within 4.5 hours after the onset and received thrombolytic therapy between December 2016 and June 2017 were studied. An immediate real time teleconsultation with 24 hours availability between neurologists at Mittaphab hospital and the Chulalongkorn stroke team was performed in all cases for patient evaluation and decision for thrombolytic treatment. Results: There were 205 patients with acute stroke, 28 patients (14%) arrived at the hospital within 4.5 hours after the onset. Ten patients (5%) were eligible for intravenous rtPA. The mean duration from onset to hospital arrival was 122.50 minutes and the mean door to needle time was 108 minutes. The mean National Institute of Health stroke scale (NIHSS) before thrombolysis was 10. At 90 days, the mean NIHSS was 3 and the mean mRS was 2. Seventy percent of patients had good outcome (mRS ≤2). Only one patient developed massive cerebral infarction. None of the patient developed symptomatic intracerebral hemorrhage or major bleedings. Conclusions: Telestroke consultation from Thailand can facilitate the thrombolytic therapy for acute ischemic stroke patients in Lao PDR.     

Use of Telemedicine and Other Strategies to Increase the Number of Patients That May Be Treated with Intravenous Thrombolysis

Stroke is the fourth leading killer in the United States and a leading cause of adult long-term disability. The American Heart Association estimates that only 3% to 5% of patients with acute ischemic stroke are treated with intravenous thrombolysis. A way to improve the rates of treatment with thrombolysis in patients with acute ischemic stroke is the creation of telemedicine stroke networks. Data from many studies support the safety of expanding intravenous tissue plasminogen activator use with the help of telemedicine. In this article we discuss the current evidence for the use of telemedicine within stroke systems of care, the importance of coordinating care within the transferring facilities in the telestroke networks, telestroke economics and applicability, and how to potentially use the telestroke systems to increase recruitment of patients into acute stroke thrombolysis trials.     

应用移动卒中单元对急性缺血性卒中院前静脉溶栓的初步探索

目的 大多数急性缺血性卒中患者难以在发病早期接受静脉溶栓治疗，而移动卒中单元（mobile stroke unit，MSU）的应用将静脉溶栓治疗从院内提到院前。本研究初步探讨中国首台MSU在急性卒中 患者院前静脉溶栓中的作用。 方法 回顾性分析荥阳市人民医院卒中中心2018年11月-2019年4月期间应用MSU进行院前静脉溶 栓的患者（MSU溶栓组）和使用传统救护车转运至院内静脉溶栓的患者（常规溶栓组）的临床资料。 观察终点包括主要时间指标从呼叫至溶栓时间、从发病至溶栓时间；疗效指标为90 d良好预后（mRS 评分≤2分）率；安全性指标包括溶栓后48 h内症状性颅内出血及随访90 d内的全因死亡。比较静脉 溶栓患者应用两种治疗模式的终点差异。 结果 MSU溶栓组共计14例患者接受了院外静脉溶栓，同时期常规溶栓组有24例患者在院内进行了 静脉溶栓治疗。与常规溶栓组相比，MSU溶栓组呼叫至溶栓时间（59 min vs 92 mi n，P =0.001）、发病 至溶栓时间（73 min vs 114 mi n，P =0.002）均较短。两组的90 d良好预后率（79% vs 67%，P =0.488） 和安全性指标均未见统计学差异。 结论 基于MSU的急性缺血性卒中院前溶栓可以显著缩短患者从发病至溶栓时间及呼叫至溶栓时 间，但对于急性卒中的救治疗效仍需要多中心前瞻性研究进一步验证。     

The establishment of a telestroke service using multimodal CT imaging decision assistance: “Turning on the fog lights”

Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke.We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21 months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes. Fifty-eight patients were assessed using telestroke, of which 41 were regarded to be acute ischemic strokes and 17 to be stroke mimics on clinical grounds. Of the 41 acute stroke patients, 22 patients were deemed eligible for thrombolysis. Using multimodal CT imaging, 8 more patients were excluded from treatment because of lack of treatment target. Multimodal imaging failed to be obtained in one patient. For the 14 treated patients, median door-imaging time was 38 min. Median door-treatment time was 91 min. A 90-day mRS ⩽2 was achieved in 40% of treated patients. We conclude that a telestroke service using advanced CT imaging for therapy decision assistance can be successfully implemented in regional Australia and can be used to guide acute stroke treatment decision-making and improve access to thrombolytic therapy. Efficiency and safety is comparable to established telestroke services.