缺血性脑卒中患者静脉溶栓治疗后，颈内动脉闭塞是否经常导致颅内出血？

Does ICA occlusion frequently have intracerebral hemorrhage after IV tissue plasminogen activator therapy for ischemic stroke?

机构信息

Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. kimurak@ med.kawasaki-m.ac.jp

出版信息

Eur Neurol. 2011;65(5):245-9. doi: 10.1159/000326338. Epub 2011 Apr 5.

Abstract

BACKGROUND/AIMS: The main predictors of intracerebral hemorrhage (ICH) are clinical stroke severity and large ischemic lesions. Therefore, ICA occlusion as severe stroke is thought to frequently have ICH after tissue plasminogen activator (t-PA) therapy. The aim of this study was to investigate whether ICA occlusion more frequently had ICH after t-PA therapy compared with other occluded arteries.

SUBJECTS AND METHODS

We prospectively studied consecutive stroke patients treated with t-PA within 3 h of onset. We investigated the frequency of ICH after t-PA therapy for each occluded artery.

RESULTS

165 patients were enrolled. Initial MRA demonstrated ICA occlusion in 38 patients, M1 in 48, M2 in 28, and BA and PCA in 12. At 24 h after t-PA infusion, 113 (68.5%) patients (non-HT group) did not have hemorrhagic transformation, 37 (22.4%; HI group) had hemorrhagic cerebral infarction and 15 (9.1%; ICH group) had ICH. The ICH group most frequently had M2 occlusion, NIHSS ≥15, and ≥1/3 of the MCA territory among the three groups. The frequency of ICH was 2.6% in no occlusion, 10.5% in ICA occlusion, 6.3% in M1, 21.4% in M2, and 8.3% in PCA and BA (p = 0.1016).

CONCLUSION

Patients with ICA occlusion did not have ICH more frequently after t-PA therapy in comparison to other occluded arteries.

摘要

背景/目的：脑出血（ICH）的主要预测因素是临床中风严重程度和大的缺血性病变。因此，人们认为严重中风的颈内动脉（ICA）闭塞在组织型纤溶酶原激活剂（t-PA）治疗后经常会发生 ICH。本研究旨在探讨与其他闭塞血管相比，ICA 闭塞在 t-PA 治疗后是否更常发生 ICH。

受试者和方法

我们前瞻性研究了发病后 3 小时内接受 t-PA 治疗的连续中风患者。我们研究了每种闭塞血管的 t-PA 治疗后 ICH 的发生率。

结果

共纳入 165 例患者。初始 MRA 显示 38 例患者 ICA 闭塞，48 例患者 M1 闭塞，28 例患者 M2 闭塞，12 例患者 BA 和 PCA 闭塞。t-PA 输注后 24 小时，113 例（68.5%）患者（非 HT 组）未发生出血性转化，37 例（22.4%；HI 组）发生出血性脑梗死，15 例（9.1%；ICH 组）发生 ICH。ICH 组中 M2 闭塞、NIHSS≥15 和 MCA 区域≥1/3 的发生率最高。三组中 ICH 的发生率分别为无闭塞 2.6%、ICA 闭塞 10.5%、M1 闭塞 6.3%、M2 闭塞 21.4%和 PCA 和 BA 闭塞 8.3%（p=0.1016）。