Department of Neurology, Mayo Clinic, W8B, 200 First Street SW, Rochester, MN 55905, USA.
Neurocrit Care. 2011 Dec;15(3):421-7. doi: 10.1007/s12028-011-9552-5.
The indications for bevacizumab (a vascular endothelial growth factor inhibitor) have been expanded recently. Despite concerns for cerebrovascular events from bevacizumab treatment, detailed clinical and radiologic information are lacking.
Using the Mayo Clinic Rochester database (January 2006-September 2010), we identified bevacizumab-treated patients who developed intracerebral hemorrhage, ischemic stroke or transient ischemic attack within 3 weeks of bevacizumab treatment. Functional recovery was assessed using the modified Rankin scale 3 months following the onset of cerebrovascular events.
Ten consecutive patients (median age 58 years, range 37-86) were included in this study. These patients received bevacizumab for a median duration of 3 months (range 2-4 months) for cancer treatment, and developed cerebrovascular events that comprised intratumoral hemorrhage (n = 7), cerebral watershed infarction (n = 1), transient ischemic attack (n = 1), and left vertebral artery occlusion (n = 1). Seven patients had chronic hypertension which was adequately controlled with a single anti-hypertensive agent. Significant increase in blood pressure was observed in nine patients during their acute presentation as compared with their baseline outpatient readings. Six patients died within 3 months of these cerebrovascular events, and the remaining four patients had modest functional recovery.
Cerebrovascular events are early and serious complications that should be considered in bevacizumab-treated patients who present with an acute neurologic deterioration.
贝伐单抗（一种血管内皮生长因子抑制剂）的适应证最近有所扩大。尽管贝伐单抗治疗存在脑血管事件的担忧，但缺乏详细的临床和影像学信息。
利用梅奥诊所罗切斯特数据库（2006 年 1 月至 2010 年 9 月），我们确定了在接受贝伐单抗治疗后 3 周内发生颅内出血、缺血性卒中和短暂性脑缺血发作的贝伐单抗治疗患者。脑血管事件发生 3 个月后，采用改良 Rankin 量表评估功能恢复情况。
本研究共纳入 10 例连续患者（中位年龄 58 岁，范围 37-86 岁）。这些患者因癌症治疗接受了中位时间为 3 个月（范围 2-4 个月）的贝伐单抗治疗，发生了包括肿瘤内出血（n=7）、脑分水岭梗死（n=1）、短暂性脑缺血发作（n=1）和左侧椎动脉闭塞（n=1）在内的脑血管事件。7 例患者患有慢性高血压，通过单一抗高血压药物得到了充分控制。与基线门诊读数相比，9 例患者在急性发作时观察到血压显著升高。6 例患者在这些脑血管事件后 3 个月内死亡，其余 4 例患者功能恢复尚可。
脑血管事件是贝伐单抗治疗患者出现急性神经功能恶化时应考虑的早期严重并发症。
