Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic.
Comprehensive Stroke Center, Department of Radiology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
Transl Stroke Res. 2018 Dec;9(6):582-588. doi: 10.1007/s12975-018-0608-0. Epub 2018 Jan 15.
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.
静脉溶栓 (IVT) 是治疗前循环 (ACS) 和后循环卒中 (PCS) 的标准治疗方法。然而，由于 PCS 的发病率较低，且 PCS 中颅内出血 (ICH) 的发病率较低，因此关于 PCS 中 IVT 后 ICH 预测因素的知识相对较少。我们的目的是确定 PCS 中 IVT 后 ICH 的预测因素。该数据集包含 1281 例连续接受 IVT 治疗的缺血性卒中 (IS) 患者，其中 158 例 (103 例男性；平均年龄 65.6±12.3 岁) 患有 PCS。收集的数据包括基线特征、常见卒中危险因素、预用药、卒中严重程度、入院时血糖水平、血压以及 IVT 前和 IVT 期间静脉降压治疗、动脉闭塞、再通率、治疗时间和 90 天临床结局。总体而言，11 (7%) 例患者发生 ICH。 logistic 回归分析显示，心房颤动 (p=0.004)、治疗时 NIHSS 神经功能缺损 (p=0.016)、意识水平降低 (p=0.003)、基底动脉闭塞 (p=0.007)、PCA 闭塞 (p=0.001) 和额外的血管内治疗 (p=0.001) 是 PCS 中 ICH 的显著预测因素。大脑干缺血性病变、椎动脉闭塞或基底动脉和大脑后动脉闭塞缺失的患者可能被认为适合 IVT 治疗，即使是在临界情况下。这些患者似乎不太可能有良好的结局，但 ICH 发生率并没有增加。与 ACS 相比，PCS 中 IVT 的时间似乎对 ICH 风险或良好结局的机会没有显著影响。
