Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy.
Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy.
复制标题
极低脑血容量病变的再灌注预示着血管内治疗后的实质血肿。
DOI：
10.1161/strokeaha.114.008171
复制
发表时间：
2015-05
期刊：
影响因子：
8.3
通讯作者：
DEFUSE 2 Investigators
中科院分区：
文献类型：
--
作者：
Mishra NK;Christensen S;Wouters A;Campbell BC;Straka M;Mlynash M;Kemp S;Cereda CW;Bammer R;Marks MP;Albers GW;Lansberg MG;DEFUSE 2 Investigators
Ischemic stroke patients with regional very low cerebral blood volume (VLCBV) on baseline imaging have increased risk of parenchymal hemorrhage (PH) following intravenous alteplase-induced reperfusion. We developed a method for automated detection of VLCBV and examined whether patients with reperfused-VLCBV are at increased risk of PH following endovascular reperfusion therapy. Receiver-operating-characteristic (ROC) analysis was performed to optimize a relative cerebral blood volume (rCBV) threshold associated with PH in patients from the DEFUSE 2 study. Regional reperfused-VLCBV was defined as regions with low rCBV on baseline imaging that demonstrated normal perfusion (Tmax<6s) on coregistered early follow-up MRI. The association between VLCBV, regional reperfused-VLCBV and PH was assessed in univariate and multivariate analyses. In 91 patients, the greatest area-under-curve (AUC) for predicting PH occurred at an rCBV threshold of <0.42 (AUC 0.77). At this threshold, VLCBV lesion volume ≥3.55 ml optimally predicted PH with 94% sensitivity and 63% specificity. Reperfused-VLCBV lesion volume was more specific (0.74) and equally sensitive (0.94). In total 18 patients developed PH, of whom 17 presented with VLCBV (39% vs 2 %; p=0.001), all of them had regional reperfusion (47% vs 0%, p=0.01) and 71% received IV alteplase. VLCBV lesion (OR 33) and bridging with IV alteplase (OR 3.8) were independently associated with PH. In a separate model, reperfused-VLCBV remained the single independent predictor of PH (OR 53). These results suggest that VLCBV can be used for risk stratification of patients scheduled to undergo endovascular therapy in trials and routine clinical practice.
