From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Stroke. 2014 Jun;45(6):1846-8. doi: 10.1161/STROKEAHA.113.004559. Epub 2014 May 1.
Data on safety of intravenous thrombolysis with recombinant tissue-type plasminogen activator for acute ischemic stroke in patients with coexisting cerebral cavernous malformations (CCMs) are scarce. We assessed the risk of thrombolysis-associated hemorrhage in these patients.
We searched our tertiary care hospital thrombolysis register for patients with CCM confirmed by MRI (3 T, Siemens, TimTrio) before thrombolysis for acute ischemic stroke. CCMs were graded into subtypes according to the Zabramski classification on the basis of their MRI appearance. The primary end point was symptomatic intracerebral hemorrhage according to European Cooperative Acute Stroke Study III (ECASS III) criteria. The secondary end point was any parenchymal hemorrhage.
In a total of 350 patients (median age, 76 years; interquartile range, 68-84; median National Institutes of Health Stroke Scale score, 8; interquartile range, 5-14; 51.4% women), CCMs were found in 9 patients (2.6%). Seven patients had a single CCM, and 2 patients had multiple CCMs with a total number of 12 CCMs in all patients. The subtype of CCMs was type III in 9 cases and type I in 3 cases. Symptomatic intracerebral hemorrhage occurred in 1 of 9 patients with CCM versus 11 of 341 patients without CCM (P=0.27). Parenchymal hemorrhage occurred in 2 of 9 patients with CCM versus 27 of 341 patients (P=0.17) without CCM.
Given the limitations of our study (mainly low number of patients with CCM), the risk of thrombolysis-associated hemorrhage in patients with CCM remains uncertain. Although our data do not suggest an increased hazard from thrombolysis in patients with CCM, larger studies are necessary to determine definitively the influence of CCMs on parenchymal hemorrhage and symptomatic intracerebral hemorrhage.
关于同时患有脑动静脉畸形（CCM）的急性缺血性脑卒中患者接受重组组织型纤溶酶原激活剂静脉溶栓治疗的安全性数据十分有限。本研究旨在评估此类患者溶栓相关出血的风险。
我们在我院接受溶栓治疗的急性缺血性脑卒中患者中，检索了经 MRI（3 T，西门子，TimTrio）确诊的 CCM 患者数据。根据 MRI 表现，按照 Zabramski 分类将 CCM 分为亚型。主要终点为符合欧洲合作急性卒中研究 III（ECASS III）标准的症状性颅内出血。次要终点为任何实质内出血。
共纳入 350 例患者（中位年龄 76 岁，四分位距 68-84 岁；中位美国国立卫生研究院卒中量表评分 8 分，四分位距 5-14 分；51.4%为女性），9 例患者（2.6%）存在 CCM。7 例患者存在单发 CCM，2 例患者存在多发 CCM，总计 12 个 CCM。9 例 CCM 患者的 CCM 亚型为 3 型，3 例患者的 CCM 亚型为 1 型。9 例 CCM 患者中有 1 例发生症状性颅内出血，341 例无 CCM 患者中有 11 例发生症状性颅内出血（P=0.27）。9 例 CCM 患者中有 2 例发生实质内出血，341 例无 CCM 患者中有 27 例发生实质内出血（P=0.17）。
鉴于本研究存在一定局限性（主要是 CCM 患者数量较少），CCM 患者溶栓相关出血的风险仍不确定。尽管本研究数据并未提示 CCM 患者溶栓治疗的风险增加，但仍需要更大规模的研究来确定 CCM 对实质内出血和症状性颅内出血的确切影响。
