Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Neurointerv Surg. 2010 Jun;2(2):115-9. doi: 10.1136/jnis.2009.000794. Epub 2010 Apr 21.
Combined analysis of the Interventional Management of Stroke I and II trials demonstrated a significant association between microcatheter contrast injections and both intracranial hemorrhage (ICH) and contrast extravasation following combined intravenous (IV) and intra-arterial (IA) thrombolysis. The reliability of these observations was tested in our local registry of IA cases.
DESIGN/METHODS: Treatment angiograms and post-procedure CTs of patients treated with combined IV/IA or IA only recombinant tissue plasminogen activator for ICA-T, M1 or M2 occlusions (n=77) were reviewed. The number of microcatheter injections (MCIs) within/distal to the target occlusion was assigned for every case. The association of MCIs to total ICH, total parenchymal hematoma (PH1+PH2) and PH2 after adjusting for significant covariates was tested.
MCIs were used in 21 (27%) cases (range MCI 0-6). Any ICH occurred in 38 (49%) cases, including eight (10%) PH1s and eight (10%) PH2s. The use of MCIs was associated with increased PH (p=0.04), PH2 (p=0.07) and total ICH (p=0.03). MCIs were associated with increased contrast extravasation (CEx) (p=0.02). ICH was observed in all CEx cases (n=5, 100% vs 46% non-CEx; p=0.03), and four (80%) CEx cases developed PH2s (p<0.01). MCIs remained associated with total ICH after adjustment for significant covariates of Thromolysis in Cerebral Infarction score, glucose level and presence of atrial fibrillation (OR 3.60; 95% CI 1.12 to 11.49, p=0.03). MCI use was the only significantly associated covariate for total PHs.
MCI use was associated with ICH and with clinically significant PHs in this cohort, providing further evidence that MCIs be reduced during IA thrombolysis.
对卒中干预治疗 I 期和 II 期试验的联合分析显示，微导管造影剂注射与联合静脉（IV）和动脉内（IA）溶栓后颅内出血（ICH）和造影剂外渗均有显著关联。我们在局部 IA 病例登记处对这些观察结果的可靠性进行了测试。
方法/设计：对接受 IV/IA 联合或仅 IA 重组组织型纤溶酶原激活剂治疗颈内动脉（ICA-T）、M1 或 M2 闭塞的患者的治疗性血管造影和术后 CT 进行了回顾。对每个病例的微导管注射（MCIs）数量（靶闭塞内/远端）进行了分配。在调整了显著协变量后，对 MCIs 与总 ICH、总实质血肿（PH1+PH2）和 PH2 的关系进行了检验。
21 例（27%）患者使用了 MCIs（范围 0-6 次）。38 例（49%）患者出现任何 ICH，其中 8 例（10%）为 PH1，8 例（10%）为 PH2。使用 MCIs 与增加 PH（p=0.04）、PH2（p=0.07）和总 ICH（p=0.03）相关。MCIs 与造影剂外渗（CEx）增加相关（p=0.02）。5 例 CEx 患者均出现 ICH（100% vs 非 CEx 46%；p=0.03），4 例（80%）CEx 患者发生 PH2（p<0.01）。在调整了血栓溶解评分、血糖水平和心房颤动存在等显著协变量后，MCIs 与总 ICH 仍相关（OR 3.60；95% CI 1.12 至 11.49，p=0.03）。MCIs 使用是总 PHs 的唯一显著相关协变量。
在本队列中，MCIs 使用与 ICH 和临床显著 PHs 相关，这进一步表明在 IA 溶栓期间应减少 MCIs 的使用。
