Tsetsou S, Amiguet M, Eskandari A, Meuli R, Maeder P, Jiang B, Wintermark M, Michel P
Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Neuroradiology. 2017 Jan;59(1):23-29. doi: 10.1007/s00234-016-1775-x. Epub 2016 Dec 27.
Haemorrhagic transformation of acute ischemic stroke (AIS) and particularly parenchymal haemorrhage (PH) remains a feared complication of intravenous thrombolysis (IVT). We aimed to identify clinical and perfusion CT (PCT) variables which are independently associated with PHs.
In this observational cohort study, based on the Acute Stroke Registry Analysis of Lausanne (ASTRAL) from 2003 to December 2013, we selected patients with AIS involving the middle cerebral artery (MCA) territory who were thrombolysed within 4.5 h of symptoms' onset and who had a good quality baseline PCT at the beginning of IVT. In addition to demographic, clinical, laboratory and non-contrast CT data, volumes of salvageable tissue and ischemic core on PCT, as well as absolute CBF and CBV values within the ischemic regions were compared in patients with and without PH in multivariate analysis.
Of the 190 included patients, 24 (12.6%) presented a PH (11 had PH1 and 13 had PH2). In multivariate analysis of the clinical and radiological variables, the lowest CBV in the core and lower body weight was both significantly associated with PH (p = 0.009 and p = 0.024, respectively).
In thrombolysed MCA strokes, maximal hypoperfusion severity depicted by lowest CBV values in the core region and lower body weight are independently correlated with PH. This information, if confirmed in other case series, may add to the stratification of revascularisation decisions in patients with a perceived high PH risk.
急性缺血性卒中（AIS）的出血性转化，尤其是脑实质出血（PH），仍然是静脉溶栓（IVT）令人担忧的并发症。我们旨在确定与脑实质出血独立相关的临床和灌注CT（PCT）变量。
在这项观察性队列研究中，基于2003年至2013年12月的洛桑急性卒中注册分析（ASTRAL），我们选择了症状发作4.5小时内接受溶栓治疗且在静脉溶栓开始时具有高质量基线PCT的大脑中动脉（MCA）区域急性缺血性卒中患者。除了人口统计学、临床、实验室和非增强CT数据外，在多变量分析中，比较了有和没有脑实质出血的患者的PCT上可挽救组织和缺血核心的体积，以及缺血区域内的绝对脑血流量（CBF）和脑血容量（CBV）值。
在纳入的190例患者中，24例（12.6%）出现脑实质出血（11例为PH1，13例为PH2）。在临床和放射学变量的多变量分析中，核心区域最低的CBV和较低的体重均与脑实质出血显著相关（分别为p = 0.009和p = 0.024）。
在接受溶栓治疗的大脑中动脉卒中患者中，核心区域最低CBV值所描绘的最大灌注不足严重程度和较低的体重与脑实质出血独立相关。如果在其他病例系列中得到证实，这些信息可能会增加对有高脑实质出血风险患者血管重建决策的分层。
