Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke
Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke
复制标题
DOI：
10.1007/s12975-018-0608-0
复制
发表时间：
2018-12-01
影响因子：
6.9
通讯作者：
Petr, Kanovsky
中科院分区：
文献类型：
--
作者：
Tomas, Dornak;Michal, Kral;Petr, Kanovsky
静脉溶栓(IVT)是前循环(ACS)和后循环卒中(PCS)的标准治疗方法。然而，由于PCS和颅内出血(ICH)在PCS中的发生率较低，对于PCS IVT后ICH的预测因素知之甚少。我们的目标是确定PCS患者IVT后脑出血的预测因素。这组患者包括1281名连续接受IVT治疗的缺血性中风(IS)患者，其中158人(103名男性，平均年龄65.6±12.3岁)患有PCS。收集的数据包括基线特征、常见的中风风险因素、用药前、中风严重程度、入院时的血糖水平、血压以及在IVT前和期间接受静脉降压治疗、动脉闭塞、再通率、治疗时间以及第90天的临床结果。总体而言，11名患者(7%)出现了脑出血。Logistic回归分析显示，房颤(p=0.004)、美国国立卫生研究院卒中评分(p=0.016)、意识水平下降(p=0.003)、基底动脉闭塞(p=0.007)、主干动脉闭塞(p=0.001)和血管内治疗(p=0.001)是PCS脑出血的显著预测因素。有脑干缺血性病变、椎动脉闭塞或无基底动脉和大脑后动脉闭塞的患者，即使在临界性病例中也可考虑进行IVT治疗。在脑出血发生率没有增加的情况下，这些患者似乎不太可能获得良好的结果。PCS患者接受IVT的时间似乎不像在ACS患者那样显著地影响ICH风险或获得良好结果的机会。
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 +/- 12.3years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p=0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p=0.016), decreased level of consciousness (p=0.003), occlusion of basilar artery (p=0.007), occlusion of PCA (p=0.001), and additional endovascular therapy (p=0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.