Khatri Pooja, Broderick Joseph P, Khoury Jane C, Carrozzella Janice A, Tomsick Thomas A
Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0525, USA.
Stroke. 2008 Dec;39(12):3283-7. doi: 10.1161/STROKEAHA.108.522904. Epub 2008 Sep 4.
During intra-arterial revascularization, either guide catheter injections of contrast in the neck or microcatheter contrast injections (MCIs) at or beyond the site of an occlusion, can be used to visualize intracranial vasculature. Neurointerventionalists vary widely in their use of MCIs for a given circumstance. We tested the hypothesis that MCIs are a risk factor for intracranial hemorrhage (ICH) in the Interventional Management of Stroke (IMS) I and II trials of combined intravenous/IA recombinant tissue plasminogen activator therapy.
All arteriograms with M1, M2, and ICA terminus occlusions were reanalyzed (n=98). The number of MCIs within or distal to the target occlusion was assigned. Postprocedure CTs were reviewed for contrast extravasation and ICH. Contrast extravasation was defined as a hyperdensity suggestive of contrast (Hounsfield unit >90) seen at 24 hours or present before 24 hours and persisting or replaced by ICH at 24 hours.
In this IMS subset, the rate of any ICH was 58% (57 of 98). More MCIs were seen in the ICH group (median=2 versus 1; P=0.04). Increased MCIs were associated with higher ICH rates (P=0.03). MCIs remained associated with ICH in multivariable analysis (P=0.01) as did baseline CT edema/mass effect, atrial fibrillation, time to intravenous recombinant tissue plasminogen activator initiation, and Thrombolysis in Cerebral Infarction reperfusion score. MCIs were also associated with contrast extravasation in unadjusted and adjusted analyses.
MCIs may risk ICH in the setting of combined intravenous/intra-arterial recombinant tissue plasminogen activator therapy, possibly due to contrast toxicity or pressure transmission by injections. MCIs should be minimized whenever possible. These findings will be tested prospectively in the IMS III trial.
在动脉内血管重建过程中，颈部的引导导管造影剂注射或闭塞部位及其远端的微导管造影剂注射（MCI）均可用于颅内血管成像。在特定情况下，神经介入医生对MCI的使用差异很大。我们在静脉内/动脉内联合重组组织型纤溶酶原激活剂治疗的卒中介入管理（IMS）I和II试验中，检验了MCI是颅内出血（ICH）危险因素的假设。
对所有存在M1、M2和颈内动脉末端闭塞的血管造影进行重新分析（n = 98）。记录目标闭塞部位内或远端的MCI数量。术后CT检查有无造影剂外渗和ICH。造影剂外渗定义为24小时时出现提示造影剂的高密度影（亨氏单位>90），或在24小时前出现并持续至24小时，或被24小时时的ICH取代。
在这个IMS亚组中，任何类型ICH的发生率为58%（98例中的57例）。ICH组的MCI更多（中位数分别为2次和1次；P = 0.04）。MCI增加与更高的ICH发生率相关（P = 0.03）。在多变量分析中，MCI与ICH仍然相关（P = 0.01），基线CT水肿/占位效应、心房颤动、静脉注射重组组织型纤溶酶原激活剂开始时间以及脑梗死溶栓再灌注评分也与ICH相关。在未校正和校正分析中，MCI也与造影剂外渗相关。
在静脉内/动脉内联合重组组织型纤溶酶原激活剂治疗的情况下，MCI可能会增加ICH风险，这可能是由于造影剂毒性或注射导致的压力传递。应尽可能减少MCI的使用。这些发现将在IMS III试验中进行前瞻性验证。
