Mericle R A, Lopes D K, Fronckowiak M D, Wakhloo A K, Guterman L R, Hopkins L N
Department of Neurological Surgery (RAM), The University of Florida Brain Institute, College of Medicine, University of Florida, Gainesville, USA.
Neurosurgery. 2000 Jun;46(6):1307-14; discussion 1314-5. doi: 10.1097/00006123-200006000-00005.
Contrast extravasation after intra-arterial thrombolysis for stroke occurs frequently and is identifiable on a computed tomographic (CT) scan, but it is often unrecognized or misdiagnosed. Few articles describing this phenomenon have been published. The clinical outcomes of patients after contrast extravasation are poorly understood. We designed a grading system to predict outcomes after contrast extravasation and tested the grading scale prospectively.
We studied 27 patients who had contrast extravasation exhibited on a CT scan immediately after intra-arterial thrombolysis. The National Institutes of Health Stroke Scale was used to quantify neurological examinations preoperatively, postoperatively, and at follow-up an average of 3 months later. A grading scale from 0 to 10 was developed from a retrospective analysis of the first 18 patients using odds ratios and Fisher's exact test. The grading system was then applied prospectively to the next 9 consecutive patients.
Six components of the grading system were weighted approximately proportional to corresponding odds ratios: 1) incomplete recanalization (3 points), 2) prolonged angiographic blush (2 points), 3) hyperdensity greater than 150 Hounsfield units (2 points), 4) lesion volume greater than 50 cc exhibited on a CT scan (1 point), 5) lesion in eloquent parenchyma (1 point), and 6) hypodensity demonstrated on an immediate postoperative CT scan (1 point). The contrast extravasation grades for each outcome category (excellent, fair, poor, died) increased in stepwise fashion. There was a direct linear correlation between the assigned grade and National Institutes of Health Stroke Scale score improvement at follow-up.
This grading system should prove useful as a preliminary guide for predicting outcomes of patients with contrast extravasation after intra-arterial thrombolysis for stroke. Further analysis in a large cohort of prospective patients is necessary to ensure extensibility.
脑卒中动脉内溶栓后造影剂外渗很常见，在计算机断层扫描（CT）上可识别，但常未被认识或误诊。描述这一现象的文章很少。造影剂外渗后患者的临床结局了解甚少。我们设计了一个分级系统来预测造影剂外渗后的结局，并对该分级量表进行了前瞻性测试。
我们研究了27例动脉内溶栓后立即在CT扫描上显示有造影剂外渗的患者。采用美国国立卫生研究院卒中量表对术前、术后及平均3个月后的随访时的神经功能检查进行量化。通过对前18例患者进行回顾性分析，利用比值比和Fisher精确检验制定了一个从0到10的分级量表。然后将该分级系统前瞻性地应用于接下来连续的9例患者。
分级系统的六个组成部分的权重与相应的比值比大致成比例：1）再通不完全（3分），2）血管造影剂滞留时间延长（2分），3）密度高于150亨氏单位（2分），4）CT扫描显示病变体积大于50立方厘米（1分），5）病变位于功能区实质（1分），6）术后即刻CT扫描显示低密度（1分）。每个结局类别（优秀、尚可、差、死亡）的造影剂外渗分级呈逐步增加。分级与随访时美国国立卫生研究院卒中量表评分改善之间存在直接线性相关性。
该分级系统作为预测脑卒中动脉内溶栓后造影剂外渗患者结局的初步指南应被证明是有用的。有必要在大量前瞻性患者中进行进一步分析以确保其可扩展性。
