Ohta Hajime, Nakano Shinichi, Yokogami Kiyotaka, Iseda Tsutomu, Yoneyama Takumi, Wakisaka Shinichiro
Division of Neurosurgery, Miyakonojo Regional Medical Center, Ooiwata, Miyazaki 885-0062, Japan.
Stroke. 2004 Apr;35(4):893-8. doi: 10.1161/01.STR.0000119751.92640.7F. Epub 2004 Feb 19.
The purpose of this study was to evaluate the correlation between appearance of angiographic early venous filling during intra-arterial reperfusion therapy and posttherapeutic hemorrhagic complications.
For the past 7 years, 104 patients prospectively underwent superselective local angiography via a microcatheter before and during intra-arterial reperfusion therapy for acute middle cerebral artery occlusion to evaluate the presence or absence of early venous filling. In principle, reperfusion therapy was discontinued just after appearance of early venous filling for fear of hemorrhage. There were 2 types of early venous filling: early filling of the thalamostriate vein from the lenticulostriate arteries and that of the cortical vein from the cortical arteries.
Among these 104 patients, 31 (29.8%) had early venous filling: 19 had early filling of the thalamostriate vein, and the other 12 had early filling of the cortical vein. Eight of the 19 patients (42.1%) and 2 of the 12 patients (16.7%) had massive hematoma with neurological worsening, whereas only 1 of the 73 patients (1.4%) without early venous filling had massive hematoma. There was a significant correlation between early venous filling and massive hematoma in both the deep (P<0.0001) and superficial (P=0.0019) middle cerebral artery territories. The sensitivity and specificity of the presence of early venous filling as an indicator of parenchymal hematoma were 71% and 83%, respectively. None of the 31 ischemic areas with early venous filling could escape cerebral infarction.
Appearance of early venous filling may indicate irreversible brain damage and may be a predictive sign for parenchymal hematoma.
本研究旨在评估动脉内再灌注治疗期间血管造影早期静脉充盈的出现与治疗后出血性并发症之间的相关性。
在过去7年中，104例患者在急性大脑中动脉闭塞的动脉内再灌注治疗前及治疗期间，通过微导管前瞻性地接受了超选择性局部血管造影，以评估早期静脉充盈的有无。原则上，由于担心出血，在早期静脉充盈出现后即停止再灌注治疗。早期静脉充盈有2种类型：豆纹动脉供血的丘脑纹状体静脉早期充盈和皮质动脉供血的皮质静脉早期充盈。
在这104例患者中，31例（29.8%）出现早期静脉充盈：19例为丘脑纹状体静脉早期充盈，另外12例为皮质静脉早期充盈。19例患者中有8例（42.1%）、12例患者中有2例（16.7%）出现大量血肿并伴有神经功能恶化，而73例无早期静脉充盈的患者中只有1例（1.4%）出现大量血肿。在大脑中动脉深支（P<0.0001）和浅支（P=0.0019）区域，早期静脉充盈与大量血肿之间均存在显著相关性。早期静脉充盈作为实质血肿指标的敏感性和特异性分别为71%和83%。31个有早期静脉充盈的缺血区域均未能避免脑梗死。
早期静脉充盈的出现可能表明存在不可逆的脑损伤，并且可能是实质血肿的一个预测征象。
