Frequency of Blood-Brain Barrier Disruption Post-Endovascular Therapy and Multiple Thrombectomy Passes in Acute Ischemic Stroke Patients
Frequency of Blood-Brain Barrier Disruption Post-Endovascular Therapy and Multiple Thrombectomy Passes in Acute Ischemic Stroke Patients
复制标题
急性缺血性卒中患者血管内治疗和多次血栓切除术后血脑屏障破坏的频率
DOI：
10.1161/strokeaha.119.025914
复制
发表时间：
2019-08-01
期刊：
影响因子：
8.3
通讯作者：
Latour, Lawrence L.
中科院分区：
文献类型：
--
作者：
Luby, Marie;Hsia, Amie W.;Latour, Lawrence L.
背景和目的-血管内治疗后高信号急性再灌注标志物（HARM）的高患病率提示血脑屏障破坏和出血风险，可能归因于需要多次血栓切除术以实现再通。接受涉及前循环的急性缺血性卒中诊断，接受或不接受IV tPA（静脉注射组织型纤溶酶原激活剂）治疗，同意参加NINDS自然史研究，并在接受血管内治疗前接受基线磁共振成像。进行HARM和出血性转化的共识图像读取。良好的临床结果被定义为0-2使用最新的修改后的兰金量表scores.Results-80例患者符合所有研究标准，并纳入分析。中位年龄为65岁，64%为女性，51%为黑人/非裔美国人，美国国立卫生研究院卒中量表中位入院评分=19，56%接受IV tPA治疗，84%的脑梗死溶栓评分为2b/3。多次通过患者在24小时的重度HARM（67% vs 29%; P=0.001）、任何出血性转化（60% vs 36%; P=0.04）和不良临床结局（67% vs 36%; P=0.008）的发生率显著更高。只有年龄（比值比，1.1; 95% CI，1.01-1.12; P=0.022）和血管内治疗后24小时的重度HARM与多次通过显著相关（比值比，7.2; 95% CI，1.93-26.92; P=0.003）。结论-在这项探索性研究中，多次血栓切除术与在24小时检测到的血脑屏障破坏的显著增加独立相关。血管内治疗后发生HARM的患者进行多次血栓切除术与单次血栓切除术的几率增加>7倍。临床试验注册- URL：https://www.clinicaltrials.gov。唯一标识符：NCT 00009243。
Background and Purpose- The high prevalence of hyperintense acute reperfusion marker (HARM) seen after endovascular therapy is suggestive of blood-brain barrier disruption and hemorrhage risk and may be attributable to multiple thrombectomy passes needed to achieve recanalization.Methods- Patients with acute stroke were included if they were screened from January 2015 through February 2019, received an acute ischemic stroke diagnosis involving the anterior circulation, treated with or without IV tPA (intravenous tissue-type plasminogen activator), consented to the NINDS Natural History Study, and imaged with a baseline magnetic resonance imaging before receiving endovascular therapy. Consensus image reads for HARM and hemorrhagic transformation were performed. Good clinical outcome was defined as 0-2 using the latest available modified Rankin Scale score.Results- Eighty patients met all study criteria and were included in the analyses. Median age was 65 years, 64% female, 51% black/African American, median admit National Institutes of Health Stroke Scale=19, 56% treated with IV tPA, and 84% achieved Thrombolysis in Cerebral Infarction score of 2b/3. Multiple-pass patients had significantly higher rates of severe HARM at 24 hours (67% versus 29%; P=0.001), any hemorrhagic transformation (60% versus 36%; P=0.04) and poor clinical outcome (67% versus 36%; P=0.008). Only age (odds ratio, 1.1; 95% CI, 1.01-1.12; P=0.022) and severe HARM at 24 hours post-endovascular therapy were significantly associated with multiple passes (odds ratio, 7.2; 95% CI, 1.93-26.92; P=0.003).Conclusions- In this exploratory study, multiple thrombectomy passes are independently associated with a significant increase in blood-brain barrier disruption detected at 24 hours. Patients with HARM post-endovascular therapy had a >7-fold increase in the odds of having multiple- versus single-pass thrombectomy.Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00009243.