Influence of Bleeding Pattern on Ischemic Lesions After Spontaneous Hypertensive Intracerebral Hemorrhage with Intraventricular Hemorrhage.
Influence of Bleeding Pattern on Ischemic Lesions After Spontaneous Hypertensive Intracerebral Hemorrhage with Intraventricular Hemorrhage.
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DOI：
10.1007/s12028-018-0516-x
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发表时间：
2018-10
影响因子：
3.5
通讯作者：
CLEAR Investigators
中科院分区：
文献类型：
--
作者：
Rivera-Lara L;Murthy SB;Nekoovaght-Tak S;Ali H;McBee N;Dlugash R;Ram M;Thompson R;Awad IA;Hanley DF;Ziai WC;CLEAR Investigators
在多达四分之一的自发性脑出血（ICH）患者中检测到伴随的急性缺血性病变。出血模式和脑室内出血（IVH）对缺血性病变风险的影响尚未研究。对入组CLEAR III随机对照试验的所有500例患者进行的回顾性队列研究，该试验采用脑室外引流进行梗阻性IVH的溶栓清除。主要结局指标为经放射学证实的缺血性病变，由安全性事件委员会报告并经两名神经科医生证实。我们评估了缺血性病变的预测因素，包括分析计算机断层扫描（CT）上的出血模式（ICH、IVH和蛛网膜下腔出血）。次要结局为30天和180天时的死亡率盲法评估和改良兰金量表（mRS）。23例（4.6%）发生在脑出血后30天内。在调整混杂因素的logistic回归模型中，与缺血性病变相关的独立风险因素是IVH体积较大（p= 0.004）和CT扫描显示的持续性蛛网膜下腔出血（p=0.03）。初始IVH体积≥ 15 mL的患者并发缺血性病变的几率是IVH体积<15 mL的患者的五倍。与无并发缺血性病变的患者相比，有缺血性病变的患者在1个月和6个月时的死亡几率显著更高（但结局不差; mRS 4-6）。在IVH急性期出现缺血性病变并不少见，并且与早期和晚期死亡率的增加显著相关。脑实质外血液（较大IVH和可见SAH）是ICH后伴随缺血性病变发展的强预测因子。
Concomitant acute ischemic lesions are detected in up to a quarter of patients with spontaneous intracerebral hemorrhage (ICH). Influence of bleeding pattern and intraventricular hemorrhage (IVH) on risk of ischemic lesions has not been investigated. Retrospective cohort study of all 500 patients enrolled in the CLEAR III randomized controlled trial of thrombolytic removal of obstructive IVH using external ventricular drainage. The primary outcome measure was radiologically-confirmed ischemic lesions, as reported by the Safety Event Committee and confirmed by two neurologists. We assessed predictors of ischemic lesions including analysis of bleeding patterns (ICH, IVH and subarachnoid hemorrhage) on computed tomography scans (CT). Secondary outcomes were blinded assessment of mortality and modified Rankin scale (mRS) at 30 and 180 days. Ischemic lesions occurred in 23 (4.6%) during first 30 days after ICH. Independent risk factors associated with ischemic lesions in logistic regression models adjusted for confounders were higher IVH volume (p= 0.004) and persistent subarachnoid hemorrhage on CT scan (p=0.03). Patients with initial IVH volume ≥15mL had five times the odds of concomitant ischemic lesions compared to IVH volume <15mL. Patients with ischemic lesions had significantly higher odds of death at 1 and 6 months (but not poor outcome; mRS 4-6) compared to patients without concurrent ischemic lesions. Occurrence of ischemic lesions in the acute phase of IVH is not uncommon, and is significantly associated with increased early and late mortality. Extra- parenchymal blood (larger IVH and visible SAH) is a strong predictor for development of concomitant ischemic lesions after ICH.
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血压降低，MRI的扩散降低以及脑出血后的结果。
影响因子：
8.3
作者：
Garg RK;Liebling SM;Maas MB;Nemeth AJ;Russell EJ;Naidech AM
通讯作者：
Naidech AM
DOI：
10.1111/ijs.12097
发表时间：
2014-06
期刊：
International journal of stroke : official journal of the International Stroke Society
影响因子：
--
作者：
Ziai WC;Tuhrim S;Lane K;McBee N;Lees K;Dawson J;Butcher K;Vespa P;Wright DW;Keyl PM;Mendelow AD;Kase C;Wijman C;Lapointe M;John S;Thompson R;Thompson C;Mayo S;Reilly P;Janis S;Awad I;Hanley DF;CLEAR III Investigators
通讯作者：
CLEAR III Investigators
影响因子：
9.9
作者：
Kimberly, W. T.;Gilson, A.;Greenberg, S. M.
通讯作者：
Greenberg, S. M.
影响因子：
2.4
作者：
Kobayashi, M;Takayama, H;Kawase, T
通讯作者：
Kawase, T
影响因子：
9.9
作者：
Bernick, C;Kuller, L;Price, T
通讯作者：
Price, T