Importance of leukoaraiosis on CT for tissue plasminogen activator decision making: Evaluation of the NINDS rt-PA Stroke Study
Importance of leukoaraiosis on CT for tissue plasminogen activator decision making: Evaluation of the NINDS rt-PA Stroke Study
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DOI：
10.1159/000139658
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发表时间：
2008-01-01
影响因子：
2.9
通讯作者：
Levine, Steven R.
中科院分区：
文献类型：
--
作者：
Demchuk, Andrew M.;Khan, Firosh;Levine, Steven R.
背景：脑白质变与脑T-2加权磁共振成像微出血相关。这种出血被认为是导致溶栓治疗后出现症状性脑出血的原因。我们在NINDS rt-PA卒中研究中研究了小血管缺血性疾病与症状性脑出血之间的关系。方法：NINDS rt-PA卒中研究的基线CT扫描由盲法专家CT阅读器使用van sweeten评分（vSS）对白质变进行回顾性重新评估。该量表在3个连续CT切片上检查白质改变的严重程度，并对中央沟前后两个不同区域分别进行分级：0 =无病变，1 =部分累及白质，2 =向上延伸至皮层。结果：603张CT片被解读。在安慰剂组和治疗组中，症状性脑出血的风险随着vSS的升高而增加。在接受rt- pa治疗的严重白质疾病患者（vSS = 3-4）中，症状性出血的绝对风险为7.9%，而接受安慰剂治疗的患者为2.9%。在严重白质病变患者（vSS = 3-4）中，与安慰剂相比，rt-PA患者没有差异治疗效果，31.6%的rt-PA治疗患者的改良Rankin评分为0-1，而安慰剂治疗患者的改良Rankin评分为14.7%。结论：本研究的结果不支持基线CT非对比扫描显示的白质变对症状出现后3小时内溶栓决策至关重要的观点。没有明确的白质病变阈值，低于此阈值静脉注射rt-PA治疗没有益处或危害。版权所有2008 S. Karger AG，巴塞尔
Background: Leukoaraiosis is associated with microhemorrhages on T-2*-weighted magnetic resonance imaging of the brain. Such hemorrhages have been postulated to be responsible for symptomatic intracerebral hemorrhage (ICH) after thrombolytic treatment. We examined the relationship between small-vessel ischemic disease and symptomatic ICH within the NINDS rt-PA Stroke Study. Methods: Baseline CT scans from the NINDS rt-PA Stroke Study were re-evaluated retrospectively by blinded expert CT readers using the van Swieten Score (vSS) for leukoaraiosis. The scale examined the severity of white-matter changes on 3 serial CT slices and graded separately for the 2 distinct regions anterior and posterior to the central sulcus: 0 = no lesion, 1 = partly involving the white matter, and 2 = extending up to the cortex. Results: 603 CT scans were interpreted. The risk of symptomatic ICH increased with higher vSS in both the placebo and treatment groups. The absolute risk of symptomatic hemorrhage was 7.9% in the rt-PA-treated cohort among patients with severe white-matter disease ( vSS = 3-4) versus 2.9% receiving placebo. Among severe leukoaraiosis patients (vSS = 3-4), no differential treatment effect was seen with rt-PA patients achieving better outcomes than placebo, modified Rankin score 0-1 in 31.6% of rt-PA-treated versus 14.7% of placebo-treated patients. Conclusion: The results from the present study do not support the concept that leukoaraiosis present on baseline noncontrast CT scanning is critical to thrombolysis decision making in the first 3 h from symptom onset. No clear leukoaraiosis threshold was identified below which no benefit or harm could be seen from intravenous rt-PA therapy. Copyright (C) 2008 S. Karger AG, Basel.