急性前循环缺血性脑卒中静脉溶栓治疗后随访脑计算机断层扫描发现颅内静脉不对称与不良预后相关。
Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome.
机构信息
Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Neurology, Department of Medicine, National University Health System, Singapore.
出版信息
J Stroke Cerebrovasc Dis. 2014 Jan;23(1):e39-45. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.007. Epub 2013 Oct 8.
BACKGROUND
Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome.
METHODS
Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/neuroradiologists. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome.
RESULTS
Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intravenous thrombolysis. The median age was 65 years (range 19-92), 44% were men, and median National Institutes of Health Stroke Scale (NIHSS) score was 16 points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) patients, whereas 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.079-1.201, P = .046), change in NIHSS score during first 24 hours (OR .737; 95% CI .672-.807, P < .0001), and ICV asymmetry on follow-up CTA (OR 20.3; 95% CI 4.67-52.07, P < .0001) independently predicted poor outcome at 3 months.
CONCLUSIONS
ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.
背景
识别急性缺血性脑卒中（AIS）后功能结局的早期预测指标对于制定康复策略非常重要。脑内静脉（ICV）引流大脑深部，彼此平行，在 CT 血管造影（CTA）上始终可见。即使它们的充盈有轻微的不对称也可以识别。我们假设颈内动脉或大脑中动脉急性闭塞的患者静脉引流会受损。由于全身溶栓可能改变血管发现，因此我们评估了随访 CTA 上 ICV 不对称与功能结局之间的关系。
方法
连续纳入 2007 年至 2010 年接受静脉溶栓治疗的 AIS 患者。2 位独立的盲法卒中神经病学家/神经放射学家评估 ICV 不对称。功能结局采用改良 Rankin 量表（mRS）在 3 个月时评估，分为良好（0-1）和不良（2-6）。分析数据以预测功能结局。
结果
在 2238 例 AIS 患者中，226 例（10.1%）前循环 AIS 患者接受了静脉溶栓治疗。中位年龄为 65 岁（范围 19-92 岁），44%为男性，中位 NIHSS 评分 16 分（范围 4-32 分）。高血压是 173 例（76.5%）患者最常见的危险因素，而 78 例（34.5%）患者有房颤。103 例（45.5%）患者在随访 CTA 上评估了 ICV 不对称。入院 NIHSS 评分（比值比 [OR] 1.07；95%置信区间 [CI] 1.079-1.201，P=.046）、24 小时内 NIHSS 评分变化（OR.737；95%CI.672-.807，P<.0001）和随访 CTA 上的 ICV 不对称（OR 20.3；95%CI 4.67-52.07，P<.0001）独立预测 3 个月时的不良结局。
结论
静脉溶栓后随访 CTA 上的 ICV 不对称是功能结局不良的早期预测指标。
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