Reduced pretreatment ipsilateral middle cerebral artery cerebral blood flow is predictive of symptomatic hemorrhage post-intra-arterial thrombolysis in patients with middle cerebral artery occlusion
Reduced pretreatment ipsilateral middle cerebral artery cerebral blood flow is predictive of symptomatic hemorrhage post-intra-arterial thrombolysis in patients with middle cerebral artery occlusion
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DOI：
10.1161/01.str.0000240687.14265.b4
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发表时间：
2006-10-01
期刊：
影响因子：
8.3
通讯作者：
Jovin, Tudor G.
中科院分区：
文献类型：
--
作者：
Gupta, Rishi;Yonas, Howard;Jovin, Tudor G.
背景和目的：脑出血（ICH）是急性缺血性卒中溶栓治疗相关的严重并发症。我们假设溶栓前脑血流量（CBF）较低的患者发生症状性脑出血（siich）的风险较高。方法：对23例急性脑卒中患者在症状出现6小时内动脉内（IA）溶栓治疗大脑中动脉（MCA）或颈内动脉末端闭塞前进行定量脑血流评估的氙气CT研究。进行单因素和多因素分析以确定ia溶栓后siich的预测因素。生成受试者工作特征曲线，以确定平均同侧CBF与siich发生之间的关系。结果：我们队列的平均年龄为68 +/- 12岁，美国国立卫生研究院卒中量表（NIHSS）的平均评分为18 +/- 3。在单因素分析中，核心梗死、高血糖和平均同侧CBF降低的患者有siich的风险。在多变量分析中，只有平均同侧CBF与较高的sICH发生率相关（优势比1.58;95% CI, 1.01 ~ 2.51; P < 0.04）。受试者工作特征曲线下面积为0.87 （95% CI, 0.76 ~ 0.97; P < 0.005）。结论：ia前溶栓较低的患者平均同侧MCA CBF在MCA或颈动脉末梢闭塞的情况下发生siich的风险明显较高。本研究确定的阈值可能对选择急性脑卒中溶栓的急性MCA闭塞患者有用。
Background and Purpose-Intracerebral hemorrhage (ICH) can be a devastating complication associated with thrombolytic therapy for acute ischemic stroke. We hypothesized that patients with lower prethrombolysis cerebral blood flow (CBF) were at a higher risk of symptomatic ICH (sICH).Methods-Twenty-three patients who underwent quantitative CBF assessment with Xenon CT studies for acute stroke before intra-arterial (IA) thrombolysis for a middle cerebral artery (MCA) or internal carotid artery terminus occlusion within 6 hours of symptom onset were studied. Univariate and multivariate analysis were carried out to determine predictors of sICH post-IA thrombolysis. Receiver operating characteristic curves were generated to determine the association between mean ipsilateral CBF and the occurrence of sICH.Results-The mean age of our cohort was 68 +/- 12 years and a mean National Institutes of Health Stroke Scale (NIHSS) score of 18 +/- 3. In univariate analysis, patients with higher percent of core infarct, hyperglycemia, and reduced mean ipsilateral CBF were at risk of sICH. In multivariate analysis only mean ipsilateral CBF was associated with higher rates of sICH (odds ratio 1.58; 95% CI, 1.01 to 2.51; P < 0.04). The area under the receiver operating characteristic curve was 0.87 (95% CI, 0.76 to 0.97; P < 0.005).Conclusions-Patients with lower pre-IA thrombolysis mean ipsilateral MCA CBF are at significantly higher risk for sICH in the setting of a MCA or carotid terminus occlusion. The threshold identified in this study may be useful for selection of patients with acute MCA occlusions for acute stroke thrombolysis.