Division of Clinical Neurosciences, University of Glasgow, Glasgow G51 4TF, UK.
Stroke. 2011 Aug;42(8):2170-4. doi: 10.1161/STROKEAHA.111.618777. Epub 2011 Jul 7.
Iodinated contrast is increasingly used in CT perfusion or angiographic examinations in acute stroke. Increased risk of intracranial hemorrhage (ICH) complicating microcatheter contrast injections has recently been reported in the second Interventional Management of Stroke (IMS 2) trial with contrast toxicity potentially contributory.
We reviewed clinical and radiological data on all patients treated with intravenous alteplase at a single center between May 2003 and November 2008.
Of 312 patients treated with intravenous alteplase, 69 (22.1%) received intravenous iodinated contrast in volumes between 50 and 150 mL. Incidence of symptomatic ICH defined as per European Cooperative Acute Stroke Study 2 was 16 of 312 (5.1%; 95% CI, 2.7% to 7.6%); among patients not given contrast, it was 12 of 243 (4.9%; 2.2% to 7.7%) compared with 4 of 69 (5.8%; 0.3% to 11.3%) in those given contrast. Incidence of symptomatic ICH defined as per Safe Implementation of Thrombolysis in Stroke-MOnitoring Study (SITS-MOST) criteria was 12 of 312 (3.9%; 1.7% to 6%), 9 of 243 (3.7%; 1.3% to 6%) among those not given contrast, and 3 of 69 (4.4%; 95% CI, -0.5% to 9.2%) among those given contrast. Patients with symptomatic ICH were older, had higher pretreatment National Institutes of Health Stroke Scale, and blood glucose than those without symptomatic ICH. In logistic regression analysis, pretreatment blood glucose was the only significant predictor of symptomatic ICH by either definition (OR, 1.23; 95% CI, 1.03 to 1.48 per mmol/L increment; P=0.024). Contrast administration or dose was not associated with symptomatic ICH.
Intravenous iodinated contrast in doses typically required for CT angiography and perfusion imaging was not associated with symptomatic intracranial hemorrhage in patients treated with alteplase.
碘造影剂在急性脑卒中的 CT 灌注或血管造影检查中应用日益广泛。最近在第二次介入性脑卒中管理试验（IMS 2）中报道了微导管造影剂注射后颅内出血（ICH）风险增加的情况，造影剂毒性可能是其促成因素。
我们对 2003 年 5 月至 2008 年 11 月在一家中心接受静脉注射阿替普酶治疗的所有患者的临床和影像学数据进行了回顾。
在 312 例接受静脉注射阿替普酶治疗的患者中，69 例（22.1%）接受了 50 至 150 毫升之间的静脉碘造影剂。根据欧洲急性脑卒中协作研究 2 标准定义的症状性 ICH 发生率为 312 例中的 16 例（5.1%；95%CI，2.7%至 7.6%）；在未接受造影剂的患者中，12 例（4.9%；2.2%至 7.7%）与接受造影剂的患者中 4 例（5.8%；0.3%至 11.3%）相比。根据安全实施溶栓治疗监测研究（SITS-MOST）标准定义的症状性 ICH 发生率为 312 例中的 12 例（3.9%；1.7%至 6%），243 例中 9 例（3.7%；1.3%至 6%）在未接受造影剂的患者中，69 例中 3 例（4.4%；95%CI，-0.5%至 9.2%）在接受造影剂的患者中。有症状性 ICH 的患者年龄较大，治疗前国立卫生研究院卒中量表和血糖水平较高。在逻辑回归分析中，治疗前血糖是两种定义的症状性 ICH 的唯一显著预测因子（OR，1.23；95%CI，每 mmol/L 增加 1.03 至 1.48；P=0.024）。造影剂的使用或剂量与症状性 ICH 无关。
在接受阿替普酶治疗的患者中，CT 血管造影和灌注成像所需的典型碘造影剂剂量与症状性颅内出血无关。
