Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China.
Department of Radiology, Dongguan People's Hospital, Dongguan, Guangdong, China.
Stroke Vasc Neurol. 2020 Dec;5(4):361-367. doi: 10.1136/svn-2020-000343. Epub 2020 Jun 24.
Early neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA).
This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. We collected clinical variables and initial haematological and neuroimaging findings. MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere. The degree of hyperintensity of MHVs was classified into four grades: none, subtle, moderate and extensive. END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms. Multivariate logistic regressions were conducted to investigate the predictors of END.
The study included 61 patients (51 males and 10 females) with a mean age of 62.4±12.6 years. Thirty-five (57.4%) patients presented with MHVs: 8 (13.1%) were graded as subtle MHVs, while 23 (37.7%) and 4 (6.6%) were graded as moderate or extensive MHVs, respectively. Twenty patients (32.8%) presented with END. Logistic regression analysis showed that compared with patients without MHVs, moderate MHVs (adjusted OR 5.446, 95% CI 1.360 to 21.800; p=0.017) and extensive MHVs (adjusted OR 15.240, 95% CI 1.200 to 193.544; p=0.036) were significantly associated with END.
MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.
早期神经功能恶化（END）是接受溶栓治疗的急性缺血性脑卒中（AIS）患者的常见特征。本研究旨在探讨磁敏感加权成像（SWI）上多发性低信号血管（MHVs）是否可以预测接受重组组织型纤溶酶原激活剂（r-tPA）治疗的前循环 AIS 患者的 END。
这是一项回顾性研究，纳入接受 r-tPA 治疗的伴有症状性大脑中动脉或颈内动脉狭窄或闭塞的 AIS 患者。我们收集了临床变量和初始血液学及神经影像学发现。SWI 检查显示静脉数量增多或静脉直径增大，信号丢失程度大于对侧半球时，定义为存在 MHVs。将 MHVs 的高信号强度程度分为 4 级：无、轻微、中度和广泛。END 定义为症状出现后 48 小时内 NIHSS 评分增加 2 分。采用多变量逻辑回归分析探讨 END 的预测因素。
本研究纳入 61 例患者（51 例男性，10 例女性；平均年龄 62.4±12.6 岁）。35 例（57.4%）患者存在 MHVs：8 例（13.1%）为轻微 MHVs，23 例（37.7%）和 4 例（6.6%）为中度或广泛 MHVs。20 例（32.8%）患者出现 END。Logistic 回归分析显示，与无 MHVs 的患者相比，中度 MHVs（调整 OR 5.446，95%CI 1.360 至 21.800；p=0.017）和广泛 MHVs（调整 OR 15.240，95%CI 1.200 至 193.544；p=0.036）与 END 显著相关。
在接受 r-tPA 治疗的伴有症状性大动脉狭窄或闭塞的 AIS 患者中，MHVs 可能是 END 的有用预测因素。
