Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
J Neurol Neurosurg Psychiatry. 2018 Aug;89(8):866-869. doi: 10.1136/jnnp-2017-317341. Epub 2018 Feb 27.
Early neurological deterioration prompting urgent brain imaging occurs in nearly 15% of patients with ischaemic stroke receiving intravenous tissue plasminogen activator (tPA). We aim to determine risk factors associated with symptomatic intracranial haemorrhage (sICH) in patients with ischaemic stroke undergoing emergent brain imaging for early neurological deterioration after receiving tPA.
We abstracted data from our prospective stroke database and included all patients receiving tPA for ischaemic stroke between 1 March 2015 and 1 March 2017. We then identified patients with neurological deterioration who underwent urgent brain imaging prior to their per-protocol surveillance imaging and divided patients into two groups: those with and without sICH. We compared baseline demographics, clinical variables, in-hospital treatments and functional outcomes at 90 days between the two groups.
We identified 511 patients who received tPA, of whom 108 (21.1%) had an emergent brain CT. Of these patients, 17.5% (19/108) had sICH; 21.3% (23/108) of emergent scans occurred while tPA was infusing, though only 4.3% of these scans (1/23) revealed sICH. On multivariable analyses, the only predictor of sICH was a change in level of consciousness (OR 6.62, 95% CI 1.64 to 26.70, P=0.008).
Change in level of consciousness is associated with sICH among patients undergoing emergent brain imaging after receiving tPA. In this group of patients, preparation of tPA reversal agents while awaiting brain imaging may reduce reversal times. Future studies are needed to study the cost-effectiveness of this approach.
接受静脉组织型纤溶酶原激活剂（tPA）治疗的缺血性脑卒中患者中，近 15%会出现促使紧急脑部成像的早期神经功能恶化。我们旨在确定在接受 tPA 治疗后因早期神经功能恶化而紧急进行脑部成像的缺血性脑卒中患者中，与症状性颅内出血（sICH）相关的危险因素。
我们从前瞻性脑卒中数据库中提取数据，纳入 2015 年 3 月 1 日至 2017 年 3 月 1 日期间接受 tPA 治疗的所有缺血性脑卒中患者。然后，我们确定了在按方案进行监测成像之前出现神经功能恶化并进行紧急脑部成像的患者，并将患者分为两组：有 sICH 组和无 sICH 组。我们比较了两组患者的基线人口统计学资料、临床变量、住院治疗和 90 天的功能结局。
我们共纳入了 511 例接受 tPA 治疗的患者，其中 108 例（21.1%）进行了紧急脑部 CT 检查。这些患者中，17.5%（19/108）出现 sICH；108 例患者中 21.3%（23/108）在 tPA 输注时进行了紧急扫描，但只有 4.3%（1/23）的扫描显示 sICH。多变量分析显示，sICH 的唯一预测因素是意识水平的变化（OR 6.62，95%CI 1.64 至 26.70，P=0.008）。
在接受 tPA 治疗后进行紧急脑部成像的患者中，意识水平的变化与 sICH 相关。在这群患者中，在等待脑部成像的同时准备 tPA 逆转剂可能会缩短逆转时间。需要进一步研究这种方法的成本效益。
