From the Department of Neurology (K.F., K.M., S.T.G., T.B., M.J.H., S.S., F.S., B.K., K.W.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany.
Department of Neuroradiology (M.S., A.D.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany.
Stroke. 2019 Jul;50(7):1682-1687. doi: 10.1161/STROKEAHA.119.025260. Epub 2019 Jun 11.
Background and Purpose- Oral angioedema (OA) is a rare but life-threatening complication in patients with ischemic stroke receiving intravenous thrombolysis with r-tPA (recombinant tissue-type plasminogen activator). This study intended to determine associations between thrombolysis-related OA and ischemic stroke lesion sites using a voxel-wise lesion analysis. Methods- Prospective registry data were used to identify ischemic stroke patients with thrombolysis-related OA between 2002 and 2018. For the study registry, ethics approval was obtained by the Ethics Committee of the Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg (clinical registry registration: 377_17Bc). Ischemic stroke patients with thrombolysis treatment but without OA admitted in the years 2011 and 2012 comprised the control group. Ischemic lesions were manually outlined on magnetic resonance imaging (1.5T or 3T) or computed tomographic scans and transformed into stereotaxic space. We determined the lesion overlap and compared the absence or presence of OA voxel-wise between patients with and without lesions in a given voxel using the Liebermeister test. Stroke severity was rated using the National Institutes of Health Stroke Scale score, and blood pressure, heart rate, blood glucose levels, and body temperature were determined on admission. Results- Fifteen ischemic stroke patients with thrombolysis-related OA were identified. The voxel-wise analysis yielded associations between OA and ischemic lesions in the insulo-opercular region with a right hemispheric dominance. Mean blood pressure was significantly lower in patients with OA than in controls. Age, National Institutes of Health Stroke Scale scores, infarct volumes, heart rate, and blood glucose levels did not differ between patients with and without OA. Conclusions- The voxel-wise analysis linked thrombolysis-related OA to right insulo-opercular lesions. The lower blood pressure in patients with thrombolysis-related OA may reflect bradykinin effects causing vasodilatation and increasing vascular permeability.
背景与目的- 接受 r-tPA（重组组织型纤溶酶原激活剂）静脉溶栓治疗的缺血性脑卒中患者会发生口腔血管性水肿（OA），这是一种罕见但危及生命的并发症。本研究旨在使用体素分析方法确定溶栓相关 OA 与缺血性脑卒中病变部位之间的相关性。方法- 使用前瞻性注册数据确定了 2002 年至 2018 年期间接受溶栓治疗的伴有溶栓相关 OA 的缺血性脑卒中患者。该研究的注册数据已获得 Friedrich-Alexander-Universität（FAU）Erlangen-Nürnberg 伦理委员会的批准（临床注册登记号：377_17Bc）。2011 年和 2012 年未发生 OA 的溶栓治疗缺血性脑卒中患者为对照组。在磁共振成像（1.5T 或 3T）或计算机断层扫描上手动勾画缺血性病灶，并将其转换为立体定向空间。我们通过 Liebermeister 检验确定病变重叠，并比较在给定体素中存在或不存在 OA 的患者之间的体素是否存在 OA。采用美国国立卫生研究院脑卒中量表（NIHSS）评分评定脑卒中严重程度，并在入院时测定血压、心率、血糖水平和体温。结果- 共确定了 15 例溶栓相关 OA 的缺血性脑卒中患者。体素分析结果表明，OA 与右半球优势的岛盖区和岛叶区的缺血性病变之间存在相关性。与对照组相比，OA 患者的平均血压明显更低。OA 患者与对照组患者的年龄、NIHSS 评分、梗死体积、心率和血糖水平无差异。结论- 体素分析将溶栓相关 OA 与右岛盖区和岛叶区病变联系起来。溶栓相关 OA 患者的血压较低可能反映了缓激肽的作用，导致血管扩张和增加血管通透性。
