Goldstein Jn, Brouwers Hb, Romero Jm, McNamara K, Schwab K, Greenberg Sm, Rosand J
Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA.
J Vasc Interv Neurol. 2012 Aug;5(supp):20-5.
The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction.
Many patients enrolled in ATACH-II will undergo CTA and/or MRI as part of routine clinical care. We will perform a blinded analysis of these images. For CTA, we will determine the presence of contrast pooling (also termed contrast extravasation or the "Spot Sign"). In addition, we will calculate a Spot Sign Score, a score that includes number of Spot Signs, diameter, and contrast density. For MRI, we will focus on the presence, number, and location of cerebral microbleeds (CMBs) on sensitive T2*-weighted MRI sequences.
We will test the hypothesis that patients with a Spot Sign will receive clinical benefit from intensive blood pressure reduction. In addition, we will determine whether patients with the highest Spot Sign Scores receive the most benefit from intensive blood pressure reduction. Finally, we will determine whether the absence of CMBs marks those at higher risk for hematoma expansion, and therefore more likely to benefit from treatment.
This ancillary study offers the tremendous opportunity to determine whether imaging findings can risk stratify ICH patients for acute therapies aimed at limiting hematoma growth.
ATACH-II试验旨在评估强化降压是否能减少血肿扩大并改善预后。然而，在就诊时很难确定哪些患者有持续出血的最高风险，以及哪些患者将从血压治疗中获得最大的临床益处。或许改进的预测标志物将有助于高效、个性化地选择最佳治疗方案。我们假设CT血管造影（CTA）和MRI上的特定影像学表现将识别出那些从强化降压中获益最大的患者。
许多参加ATACH-II试验的患者将接受CTA和/或MRI检查，作为常规临床护理的一部分。我们将对这些图像进行盲法分析。对于CTA，我们将确定是否存在造影剂聚集（也称为造影剂外渗或“斑点征”）。此外，我们将计算斑点征评分，该评分包括斑点征的数量、直径和造影剂密度。对于MRI，我们将重点关注敏感的T2*加权MRI序列上脑微出血（CMB）的存在、数量和位置。
我们将检验有斑点征的患者将从强化降压中获得临床益处这一假设。此外，我们将确定斑点征评分最高的患者是否从强化降压中获益最大。最后，我们将确定无CMB是否标志着血肿扩大风险较高的患者，因此更有可能从治疗中获益。
这项辅助研究提供了一个绝佳的机会，以确定影像学表现是否可以对脑出血患者进行风险分层，以便采取旨在限制血肿生长的急性治疗措施。
