Department of Radiology, University of Cincinnati Hospital, 234 Goodman Street, ML 0762, Cincinnati OH 45267-0762, USA.
Stroke. 2010 May;41(5):1013-7. doi: 10.1161/STROKEAHA.110.578245. Epub 2010 Apr 1.
Observations in human interventional stroke treatment led us to hypothesize that iodinated radiographic contrast material use may contribute to intracerebral hemorrhage. Effects of intra-arterial iodinated radiographic contrast material on hemorrhagic transformation after middle cerebral artery occlusion and reperfusion were studied in a placebo-controlled, blinded preclinical study in rats.
Four groups of male Sprague-Dawley rats were studied: saline group (n=8), contrast group (n=12), heparin group (n=9), and contrast+heparin group (n=9). The middle cerebral artery was occluded for 5 hours using suture placement. Heparin was infused before suture removal and reperfusion. Saline and/or contrast were infused immediately during reperfusion. Incidence, location, and size of hemorrhage were determined by brain necropsy inspection at 24 hours.
There was a significant increase in incidence of cortical hemorrhage from control (37.5%), contrast (75.0%), heparin (77.8%) to contrast+heparin (100%; Cochran-Mantel-Haenszel correlation, P<0.01). Both pooled contrast groups (85.7%) and pooled heparin groups (88.9%) had higher rates of cortical intracerebral hemorrhage compared with the control group (P<0.05). Similar trends for increased cortical intracerebral hemorrhage were seen in the contrast-only (P=0.18) and heparin-only (P=0.18) groups. There was a trend for decreased infarct edema in rats receiving contrast versus those without (P=0.06).
Intraarterial iodinated radiographic contrast material may increase cortical intracerebral hemorrhage, similar to heparin. Iodinated radiographic contrast material effect may be additive to heparin effect on the incidence of cortical intracerebral hemorrhage.
在人类介入性中风治疗中的观察结果使我们假设，使用含碘造影剂可能导致脑出血。本研究旨在通过一项安慰剂对照、盲法的临床前大鼠研究，探讨经动脉内给予含碘造影剂对大脑中动脉闭塞再灌注后出血转化的影响。
研究共纳入 4 组雄性 Sprague-Dawley 大鼠：盐水组（n=8）、造影剂组（n=12）、肝素组（n=9）和造影剂+肝素组（n=9）。采用缝线放置法将大脑中动脉闭塞 5 小时。在缝线移除和再灌注前输注肝素。在再灌注期间立即输注盐水和/或造影剂。通过脑尸检检查在 24 小时确定出血的发生率、位置和大小。
皮质出血的发生率从对照组（37.5%）、造影剂组（75.0%）、肝素组（77.8%）显著增加至造影剂+肝素组（100%；Cochran-Mantel-Haenszel 相关性，P<0.01）。两组造影剂组（85.7%）和两组肝素组（88.9%）的皮质内脑出血发生率均高于对照组（P<0.05）。在仅使用造影剂组（P=0.18）和仅使用肝素组（P=0.18）中也观察到皮质内脑出血发生率增加的类似趋势。与未使用造影剂的大鼠相比，使用造影剂的大鼠梗死水肿程度有降低的趋势（P=0.06）。
经动脉内给予含碘造影剂可能增加皮质内脑出血，类似于肝素。碘造影剂的作用可能与肝素对皮质内脑出血发生率的作用相加。
