Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Vic., Australia.
Department of Medicine, University of Melbourne, Parkville, Vic., Australia.
Epilepsia. 2018 Feb;59(2):403-409. doi: 10.1111/epi.13982. Epub 2017 Dec 30.
Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy.
Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset. Patients were followed for up to 2 years for seizure occurrence.
A total of 205 (57.1% male) patients were analyzed. Median age was 69 years (interquartile range [IQR] 57-78). Among patients with HT, 17.9% (10/56) developed poststroke seizures compared with 4.0% (6/149) among those without HT (hazard ratio [HR] 5.52; 95% confidence interval [CI] 2.00-15.22; P = .001). The association remained significant after adjustment for cortical involvement, baseline National Institutes of Health Stroke Scale score, age and use of intravenous tissue plasminogen activator and clot retrieval (HR 4.85; 95% CI 1.60-14.76; P = .005). In patients who developed seizures within the follow-up period, median time to first seizure was 111 days (IQR 28-369) in patients with HT and 36 days (IQR 0.5-183) in patients without HT.
A patient who develops HT following endovascular therapy for acute ischemic stroke had a nearly 5 times higher rate of developing poststroke seizures within 2 years. HT may be used as an imaging biomarker for poststroke seizures.
血管内治疗最近已成为选择的急性缺血性脑卒中患者的标准治疗方法。血管内治疗后，梗死脑组织可能发生出血性转化（HT）。我们研究了 HT 与血管内治疗患者卒中后癫痫发作的发生之间的关系。
连续纳入接受血管内治疗的急性前循环缺血性卒中患者。HT 通过卒中发病后 24 小时的计算机断层扫描/磁共振成像（CT/MRI）评估。患者接受了长达 2 年的随访，以观察癫痫发作的发生情况。
共分析了 205 例（57.1%为男性）患者。中位年龄为 69 岁（四分位距 [IQR] 57-78）。在发生 HT 的患者中，17.9%（10/56）发生卒中后癫痫发作，而在未发生 HT 的患者中为 4.0%（6/149）（风险比 [HR] 5.52；95%置信区间 [CI] 2.00-15.22；P =.001）。在调整皮质受累、基线国立卫生研究院卒中量表评分、年龄和使用静脉内组织型纤溶酶原激活物和血栓切除术的情况下，该关联仍然显著（HR 4.85；95%CI 1.60-14.76；P =.005）。在随访期间发生癫痫发作的患者中，发生 HT 的患者首次癫痫发作的中位时间为 111 天（IQR 28-369），而未发生 HT 的患者为 36 天（IQR 0.5-183）。
接受急性缺血性卒中血管内治疗后发生 HT 的患者在 2 年内发生卒中后癫痫发作的风险增加近 5 倍。HT 可作为卒中后癫痫发作的影像学生物标志物。
