Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis
Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis
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DOI：
10.1111/ijs.12626
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发表时间：
2015-12-01
影响因子：
6.7
通讯作者：
Kanovsky, Petr
中科院分区：
文献类型：
--
作者：
Dornak, Tomas;Kral, Michal;Kanovsky, Petr
背景静脉溶栓被认为是急性缺血性脑卒中的标准特异性再灌注治疗，包括前循环和后循环。后循环卒中患者给予重组组织型纤溶酶原激活剂治疗后24天的预后和颅内出血的发生率，并比较后循环卒中和前循环卒中的颅内出血风险。包括877例连续急性缺血性卒中患者（777例前循环卒中; 100例后循环卒中），这些患者接受了标准剂量为0.9 mg/kg的重组组织型纤溶酶原激活剂静脉溶栓治疗。以下因素的作用进行了评估：提出的特点，颅内出血分类根据ECASS I，死亡率，90天的临床结果评估使用修改后的兰金scale.Results良好的临床结果（修改后的兰金规模0-2），注意到在59%的后循环中风患者，死亡率为19%。后循环卒中患者的脑出血发生率显著低于前循环卒中患者（5.1 vs. 17.2%; P = 0.002）。前循环卒中患者大出血（实质性血肿1和2）的风险高5.2倍（P = 0.007）。以下额外的统计学显着差异之间发现后循环中风和前循环中风患者：中位年龄，男性，房颤，高脂血症，治疗的中位数时间，和入院时的血糖水平中位数。结论我们的研究表明，后循环中风与颅内出血的风险较低，前循环中风是。
Background Intravenous thrombolysis is considered to be the standard specific reperfusion therapy in acute ischemic stroke in both anterior and posterior cerebral circulation.Aims Our aim was to evaluate the 90-day outcome and rate of intracranial hemorrhage after recombinant tissue plasminogen activator administration in posterior circulation stroke and to compare the intracranial hemorrhage risk for posterior circulation stroke and anterior circulation stroke.Methods The set consisted of 877 consecutive acute ischemic stroke patients (777 anterior circulation stroke; 100 posterior circulation stroke) who underwent intravenous thrombolysis with recombinant tissue plasminogen activator in a standard dose of 0.9 mg/kg. The role of following factors was assessed: presenting characteristics, intracranial hemorrhage classification according to ECASS I, mortality, and 90-day clinical outcome assessed using the modified Rankin scale.Results Good clinical outcomes (modified Rankin scale 0-2) were noted in 59% of posterior circulation stroke patients, with a mortality rate of 19%. Intracerebral hemorrhage was significantly less frequent in posterior circulation stroke than in anterior circulation stroke patients (5.1 vs. 17.2%; P = 0.002). The risk of large hemorrhage (parenchymal hematoma 1 and 2) was 5.2 times higher in anterior circulation stroke patients (P = 0.007). The following additional statistically significant differences were found between posterior circulation stroke and anterior circulation stroke patients: median age, male gender, presence of atrial fibrillation, hyperlipidemia, median time to treatment, and median blood glucose level on admission.Conclusions Our study suggests that posterior circulation stroke is associated with a lower risk of intracranial hemorrhage than anterior circulation stroke is.