The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage
The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage
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DOI：
10.1111/ene.12764
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发表时间：
2015-11-01
影响因子：
5.1
通讯作者：
Shin, H. -W.
中科院分区：
文献类型：
--
作者：
Kim, J. -M.;Park, K. -Y.;Shin, H. -W.
背景和目的急性缺血性卒中患者血管内再灌注治疗后立即进行的非对比剂脑CT检查的对比剂累积的预后价值，以预测有症状的hemorrhages.MethodsBetween 2007年7月和2014年8月，包括接受动脉内溶栓或血栓切除术治疗的急性前循环缺血性卒中患者。造影剂积聚定义为血管内再灌注治疗后立即进行的非造影剂脑计算机断层扫描的高衰减区域，根据造影剂的存在和位置将患者分为三组：（i）阴性，（ii）皮质受累和（iii）非皮质受累。24小时后的症状性出血和功能的结果在出院时的患者之间进行了比较，有和没有皮质involved.ResultsOf 64例患者进行了血管内介入治疗，造影剂积累检测在56，包括33例皮质受累和23例皮质不参与。与非皮质受累组相比，皮质受累组更常伴有症状性出血（13例vs. 1例，P=0.003），出院时改良兰金量表评分为5或6分（14例vs. 4例，P=0.048）。包括初始侧支状态和闭塞部位的多变量logistic回归分析显示，皮质受累模式独立预测血管内治疗后症状性出血（优势比19.0，置信区间1.6 -227.6，P=0.020）。
Background and purposeThe prognostic value of contrast accumulation from non-contrast brain computed tomography taken immediately after endovascular reperfusion treatment in acute ischaemic stroke patients to predict symptomatic hemorrhage was studied.MethodsBetween July 2007 and August 2014, acute anterior circulation ischaemic stroke patients who were treated by intra-arterial thrombolysis or thrombectomy were included. Contrast accumulation was defined as a high attenuation area from non-contrast brain computed tomography immediately taken after endovascular reperfusion treatment, and patients were categorized into three groups according to the presence and location of contrast: (i) negative, (ii) cortical involvement and (iii) non-cortical involvement. The rates of symptomatic hemorrhage after 24h and functional outcome at discharge were compared between patients with and without cortical involvement.ResultsOf 64 patients who were treated by endovascular intervention, contrast accumulation was detected in 56, including 33 patients with cortical involvement and 23 patients without cortical involvement. The cortical involvement pattern was more frequently associated with symptomatic hemorrhage (13 vs. 1 patient, P=0.003) and with grave outcome at discharge with modified Rankin Scale 5 or 6 (14 vs. 4, P=0.048) than the non-cortical involvement group. Multivariate logistic regression analysis including initial collateral status and occlusion site disclosed that cortical involvement pattern independently predicted symptomatic hemorrhage after endovascular treatment (odds ratio19.0, confidence interval1.6-227.6, P=0.020).ConclusionOur study provides evidence that the cortical involvement of contrast accumulation is associated with symptomatic hemorrhage after endovascular reperfusion treatment.