Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis
Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis
复制标题
碘造影剂与静脉溶栓后脑出血
作者：
N. MacDougall;F. Mcverry;S. Baird;T. Baird;E. Teasdale;K. Muir
背景和目的-碘造影剂越来越多地用于急性卒中的CT灌注或血管造影检查。最近在第二项卒中介入治疗（IMS 2）试验中报告了微导管造影剂注射并发颅内出血（ICH）的风险增加，造影剂毒性可能是促成因素。方法：我们回顾了2003年5月至2008年11月在一个中心接受静脉阿替普酶治疗的所有患者的临床和影像学数据。结果-在接受静脉阿替普酶治疗的312例患者中，69例（22.1%）接受了50 - 150 mL体积的静脉碘化造影剂。根据欧洲急性卒中合作研究2定义的症状性ICH的发生率为16/312（5.1%; 95% CI，2.7%-7.6%）;在未给予造影剂的患者中，12/243（4.9%; 2.2%-7.7%），而在给予造影剂的患者中，4/69（5.8%; 0.3%-11.3%）。根据安全实施卒中溶栓监测研究（SITS-MOST）标准定义的症状性ICH的发生率为12/312（3.9%; 1.7%-6%），未给予造影剂的患者为9/243（3.7%; 1.3%-6%），给予造影剂的患者为3/69（4.4%; 95%CI，-0.5%至9.2%）。有症状的ICH患者年龄较大，治疗前美国国立卫生研究院卒中量表评分和血糖高于无症状的ICH患者。在logistic回归分析中，治疗前血糖是两种定义中唯一显著的症状性ICH预测因子（OR，1.23; 95%CI，每mmol/L增加1.03 - 1.48; P=0.024）。造影剂给药或剂量与症状性ICH无关。结论：在接受阿替普酶治疗的患者中，CT血管造影和灌注成像所需剂量的静脉碘造影剂与症状性颅内出血无关。
Background and Purpose— Iodinated contrast is increasingly used in CT perfusion or angiographic examinations in acute stroke. Increased risk of intracranial hemorrhage (ICH) complicating microcatheter contrast injections has recently been reported in the second Interventional Management of Stroke (IMS 2) trial with contrast toxicity potentially contributory. Methods— We reviewed clinical and radiological data on all patients treated with intravenous alteplase at a single center between May 2003 and November 2008. Results— Of 312 patients treated with intravenous alteplase, 69 (22.1%) received intravenous iodinated contrast in volumes between 50 and 150 mL. Incidence of symptomatic ICH defined as per European Cooperative Acute Stroke Study 2 was 16 of 312 (5.1%; 95% CI, 2.7% to 7.6%); among patients not given contrast, it was 12 of 243 (4.9%; 2.2% to 7.7%) compared with 4 of 69 (5.8%; 0.3% to 11.3%) in those given contrast. Incidence of symptomatic ICH defined as per Safe Implementation of Thrombolysis in Stroke-MOnitoring Study (SITS-MOST) criteria was 12 of 312 (3.9%; 1.7% to 6%), 9 of 243 (3.7%; 1.3% to 6%) among those not given contrast, and 3 of 69 (4.4%; 95% CI, −0.5% to 9.2%) among those given contrast. Patients with symptomatic ICH were older, had higher pretreatment National Institutes of Health Stroke Scale, and blood glucose than those without symptomatic ICH. In logistic regression analysis, pretreatment blood glucose was the only significant predictor of symptomatic ICH by either definition (OR, 1.23; 95% CI, 1.03 to 1.48 per mmol/L increment; P=0.024). Contrast administration or dose was not associated with symptomatic ICH. Conclusions— Intravenous iodinated contrast in doses typically required for CT angiography and perfusion imaging was not associated with symptomatic intracranial hemorrhage in patients treated with alteplase.