Early disruption of the blood-brain barrier after thrombolytic therapy predicts hemorrhage in patients with acute stroke
Early disruption of the blood-brain barrier after thrombolytic therapy predicts hemorrhage in patients with acute stroke
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DOI：
10.1161/strokeaha.107.505420
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发表时间：
2008-08-01
期刊：
影响因子：
8.3
通讯作者：
Terborg, Christoph
中科院分区：
文献类型：
--
作者：
Kastrup, Andreas;Groeschel, Klaus;Terborg, Christoph
背景和目的--血脑屏障的渗漏可以在增强后的T1加权MRI上检测到。虽然早期中断的血脑屏障似乎是一个重要的危险因素，组织纤溶酶原激活剂相关的arrhages在啮齿类动物，很少有人知道他们的发病率和后果在人类stroke. Methods，这是一个回顾性分析的前瞻性收集的中风数据库在过去的6年。在52例患者中，多模式MRI（包括弥散加权，灌注加权，和对比增强后T1加权MRI检测血脑屏障的变化）进行了系统性溶栓治疗前立即和48例患者中的中位数为30分钟（四分位数范围：30至60分钟）重组组织纤溶酶原激活剂治疗后。症状性出血（SICH）的发病率，定义为任何实质性出血导致恶化的患者的临床状况，与几个临床和影像学变量，包括早期血脑屏障changes.Results-Overall，SICH被检测到9（9%）例，其中，2人死亡。尽管溶栓前未检测到血脑屏障变化，但在组织型纤溶酶原激活剂治疗后，48例患者中有3例（6.25%）在初始梗死区域出现实质性钆增强。所有3例患者均在对应于增强区域的部位发生SICH。实质增强的存在与SICH显着相关（P < 0.01），而其他临床和影像学变量并没有预测SICH在这series.Conclusion-Early实质增强静脉注射组织纤溶酶原激活剂后显着相关，随后SICH，因此可能成为一个有用的影像学标志，为快速启动预防策略在未来。
Background and Purpose-Leaks of the blood-brain barrier can be detected on postcontrast-enhanced T1-weighted MRIs. Although early disruptions of the blood-brain barrier appear to be an important risk factor for tissue plasminogen activator-related hemorrhages in rodents, little is known about their incidence and consequences in human stroke.Methods-This is a retrospective analysis of a prospectively collected stroke database over the past 6 years. In 52 patients, multimodal MRI (including diffusion-weighted, perfusion-weighted, and postcontrast-enhanced T1-weighted MRI to detect blood-brain barrier changes) had been performed immediately before systemic thrombolysis and in 48 patients within a median of 30 minutes (interquartile range: 30 to 60 minutes) after recombinant tissue plasminogen activator treatment. The incidence of symptomatic hemorrhage (SICH), defined as any parenchymal hemorrhage leading to deterioration in the patient's clinical condition, was related to several clinical and imaging variables, including early blood-brain barrier changes.Results-Overall, SICH was detected in 9 (9%) patients and among these, 2 died. Although no blood-brain barrier changes were detectable before thrombolysis, 3 of 48 patients (6.25%) had a parenchymal gadolinium enhancement in the areas of initial infarction after tissue plasminogen activator treatment. All 3 patients developed SICHs at sites corresponding to the areas of enhancement. The presence of a parenchymal enhancement was significantly associated with SICH (P < 0.01), whereas other clinical and imaging variables did not predict SICH in this series.Conclusion-Early parenchymal enhancement after intravenous tissue plasminogen activator is significantly associated with subsequent SICH and could therefore become a useful imaging sign for the rapid initiation of preventive strategies in the future.