From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Stroke. 2014 Jun;45(6):1657-63. doi: 10.1161/STROKEAHA.114.004923. Epub 2014 May 1.
Intracerebral hemorrhage after treatment with intravenous recombinant tissue-type plasminogen activator for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, 3-month mortality, and functional outcome in patients with the poorly understood complication of remote intracerebral hemorrhage, as well as local intracerebral hemorrhage.
In this study, 43 494 patients treated with intravenous recombinant tissue-type plasminogen activator, with complete imaging data, were enrolled in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2002 to 2011. Baseline data were compared among 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with PH, 438 (1.0%) with both PH and PHr, and 39 761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression.
Previous stroke (P=0.023) and higher age (P<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, computed tomographic hyperdense cerebral artery sign, and elevated blood glucose were associated with PH, but not with PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than in PH (34% versus 24%; P<0.001), whereas 3-month mortality was lower (34% versus 39%; P<0.001).
Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke.
静脉注射重组组织型纤溶酶原激活物治疗缺血性脑卒中后，颅内出血可发生在梗死灶局部，也可发生在远离梗死组织的脑区。我们旨在描述发病机制尚不清楚的远隔部位脑实质出血（PHr）以及局部脑实质出血患者的危险因素、3 个月死亡率和功能结局。
本研究纳入了 2002 年至 2011 年期间在 Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register（SITS-ISTR）登记的 43494 例接受静脉注射重组组织型纤溶酶原激活物治疗的患者，这些患者均具有完整的影像学资料。根据有无远隔部位脑实质血肿（PHr）、有无脑实质血肿（PH）、有无同时存在 PH 和 PHr、有无 PHr 和 PH 将 970 例（2.2%）患者分为 4 组，比较各组间的基线资料。多变量逻辑回归分析确定所有出血类型的独立危险因素。
既往卒中（P=0.023）和高龄（P<0.001）与 PHr 独立相关，但与 PH 无关。心房颤动、CT 高密度大脑中动脉征和高血糖与 PH 相关，与 PHr 无关。女性与 PHr 的相关性强于与 PH 的相关性。PHr 组患者 3 个月时功能独立的比例高于 PH 组（34%比 24%；P<0.001），但 3 个月死亡率较低（34%比 39%；P<0.001）。
危险因素谱的差异表明，PHr 与既往血管病变有关，而 PH 与急性大血管闭塞有关。需要进一步研究既往脑血管病对急性缺血性脑卒中再通治疗并发症的影响。
