治疗期末颅内和脑室出血体积预测结局:MISTIE III 的二次分析。
End-of-Treatment Intracerebral and Ventricular Hemorrhage Volume Predicts Outcome: A Secondary Analysis of MISTIE III.
机构信息
From the Departments of Neurology (A.d.H., S.A., A.D.), Clinical Neurosciences Center, University of Utah, Salt Lake City.
Neurosurgery (E.J., P.T., R.G.), Clinical Neurosciences Center, University of Utah, Salt Lake City.
出版信息
Stroke. 2020 Feb;51(2):652-654. doi: 10.1161/STROKEAHA.119.028199. Epub 2019 Dec 17.
Background and Purpose- Trials have shown potential clinical benefit for minimally invasive clot evacuation of intracerebral hemorrhage (ICH). Prior research showing an association between ICH size and functional outcome did not fully address the spectrum of hematoma volumes seen after clot evacuation. Methods- In this secondary analysis of the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III), we included patients randomized to the surgical arm. The primary outcome was good outcome (modified Rankin Scale score 0-3 at 1 year from study enrollment). The primary predictors were the end-of-treatment (EoT) ICH and intraventricular hemorrhage volumes and an end-of-treatment ICH stratification scale called the EoT ICH volume score. Results- In 246 patients, the end-of-treatment computed tomography was performed an average of 5 days from onset. For patients with good versus poor outcomes, the mean end-of-treatment ICH and intraventricular hemorrhage volumes were 12.9 versus 18.0 mL (=0.002) and 0.5 versus 2.3 mL (<0.001), respectively. The probability of a good outcome decreased from 73% for EoT ICH volume 3 (<5 mL) to 28% for EoT ICH volume 0 (>20 mL; =0.001). Conclusions- After surgical clot evacuation, both ICH and intraventricular hemorrhage volumes have a strong association with good neurological outcome. The EoT ICH volume score needs independent verification, but such an approach could be used for prognostication and therapeutic planning.
背景与目的-试验表明微创清除颅内血肿(ICH)具有潜在的临床益处。先前的研究表明 ICH 大小与功能结局之间存在关联,但并未充分解决清除血肿后血肿体积的范围。方法-本研究对 MISTIE III 试验(微创手术加阿替普酶治疗颅内血肿清除 III)进行了二次分析,纳入随机分配至手术组的患者。主要结局为 1 年时改良 Rankin 量表评分 0-3(从研究入组起)。主要预测指标为治疗结束时(EoT)ICH 和脑室内出血体积以及一种称为 EoT ICH 体积评分的 EoT ICH 分层量表。结果-在 246 例患者中,治疗结束时的 CT 平均在发病后 5 天进行。对于预后良好和预后不良的患者,EoT ICH 和脑室内出血的平均体积分别为 12.9 毫升和 18.0 毫升(=0.002)和 0.5 毫升和 2.3 毫升(<0.001)。EoT ICH 体积为 3 毫升(<5 毫升)的患者,良好预后的概率为 73%,而 EoT ICH 体积为 0 毫升(>20 毫升)的患者,良好预后的概率为 28%(=0.001)。结论-手术清除血肿后,ICH 和脑室内出血体积均与良好的神经功能结局密切相关。EoT ICH 体积评分需要独立验证,但这种方法可用于预后判断和治疗计划。
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