Bhatt Archit, Vora Nirav A, Thomas Ajith J, Majid Arshad, Kassab Mounzer, Hammer Maxim D, Uchino Ken, Wechsler Lawrence, Jovin Tudor G, Gupta Rishi
Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University, East Lansing, Michigan, USA.
Neurosurgery. 2008 Nov;63(5):874-8; discussion 878-9. doi: 10.1227/01.NEU.0000333259.11739.AD.
Intra-arterial therapies are being used more frequently in patients presenting with acute cerebral occlusions, but they have been limited by the potential for hemorrhage. We sought to determine whether pretreatment computed tomography perfusion parameters might help to identify patients at a higher risk of developing intracranial hemorrhage after intra-arterial stroke revascularization treatment.
We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University who underwent computed tomography perfusion imaging of the brain before intra-arterial thrombolysis between January 2006 and June 2007. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the independent predictors of developing intracranial hemorrhage.
A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 +/- 13 years and mean National Institutes of Health Stroke Scale scores of 16 +/- 5 were studied. The overall recanalization (Thrombolysis in Myocardial Infarction Trial scale 2 or 3 flow) was 72% for the cohort, and the overall rate of parenchymal hemorrhage was 5 of 57 (9%) patients. The overall hemorrhage rate was 19 of 57 (33%) patients. The only variable found to be predictive of the development of hemorrhage after intervention was reduced pretreatment cerebral blood volume (odds ratio, 0.49; 95% confidence interval, 0.35-0.91; P < 0.022).
A reduced pretreatment ipsilateral cerebral blood volume value before endovascular revascularization of an acute middle cerebral artery or internal carotid artery occlusion significantly increases the risk of an intracranial hemorrhage.
动脉内治疗在急性脑梗死患者中应用越来越频繁，但因存在出血风险而受到限制。我们试图确定治疗前的计算机断层扫描灌注参数是否有助于识别动脉内卒中血管再通治疗后发生颅内出血风险较高的患者。
我们回顾性分析了2006年1月至2007年6月期间在匹兹堡大学医学中心和密歇根州立大学接受动脉内溶栓治疗前进行脑部计算机断层扫描灌注成像的所有患者。记录人口统计学信息、血管造影变量和血管内介入类型。记录同侧和对侧大脑中动脉区域的平均通过时间和脑血容量。构建二元逻辑回归模型以确定发生颅内出血的独立预测因素。
共研究了57例患者（33例来自匹兹堡大学，24例来自密歇根州立大学），平均年龄66±13岁，美国国立卫生研究院卒中量表平均评分16±5分。该队列的总体再通率（心肌梗死溶栓试验2级或3级血流）为72%，实质内出血的总体发生率为57例中的5例（9%）。总体出血率为57例中的19例（33%）。发现唯一可预测干预后出血发生的变量是治疗前脑血容量降低（比值比，0.49；95%置信区间，0.35 - 0.91；P < 0.022）。
急性大脑中动脉或颈内动脉闭塞进行血管内再通治疗前，同侧治疗前脑血容量值降低会显著增加颅内出血风险。
