Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
Department of Statistics, University of Missouri, Columbia, MO, USA.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107962. doi: 10.1016/j.jstrokecerebrovasdis.2024.107962. Epub 2024 Aug 25.
Post thrombolytic intracerebral hemorrhage (ICH) is associated with higher rate of death or disability in acute ischemic stroke patients. We investigated the relationship between post thrombolytic ICH volume and change in volume and death or disability at 90 days in acute ischemic stroke patients.
We analyzed 110 patents recruited in the Safety Evaluation of 3K3A-APC in Ischemic Stroke (RHAPSODY) trial who received intravenous tissue plasminogen activator (tPA) followed by mechanical thrombectomy (if indicated) and 3K3A-APC or placebo. ICH volume was measured at Day 2 and Day 7 using susceptibility weighted sequence (SWI) on magnetic resonance imaging (MRI). We also calculated the post thrombolytic ICH volume change between Day 2 and Day 7. Outcomes were determined by using utility weighted modified Rankin scale (UW-mRs) at 90-days, Outcomes were determined by using utility weighted modified Rankin scale (UW-mRS) at 90 days. To minimize interpretation bias, outcome assessors were blinded to the treatment allocation and clinical data.We adjusted for age, gender, National Institutes of Health Stroke Scale (NIHSS) score (<10,10-19 and ≥20), location of hemorrhage (single basal ganglia hemorrhage, single lobar, single cerebellum, and multiple sites) in multivariate regression analysis.
A total of 88 (80%) of 110 patients had post thrombolytic ICH (mean volume 28.3 ml ± SD 62 ml). The strata of ICH volume were not associated with UW-mRs at 90 days: <20 cc (regression coefficient (RC)-0.05, p= 0.58), 20-39 cc (RC-0.22, p=0.17), or ≥40 cc (RC-0.34, p= 0.083) compared with no ICH after adjusting for potential confounders. Change in ICH mean volume 26.78 ml ±59.68, 52 had increase in volume) between Day 2 and day 7 was not associated with UW-mRS at 90 days (RC -67.71, p= 0.06).
We did not observe any independent effect of post thrombolytic ICH volume on death or disability in acute ischemic stroke patients. Although further studies must be done, our data suggest that strategies to prevent ICH expansion such as antifibrinolytic medications and reduction in ICH volume such as surgical evacuation may not reduce death or disability in acute ischemic stroke patients with post thrombolytic ICH.
溶栓后脑出血（ICH）与急性缺血性脑卒中患者的死亡率或残疾率升高有关。我们研究了急性缺血性脑卒中患者溶栓后 ICH 体积与第 90 天时体积变化和死亡或残疾之间的关系。
我们分析了 110 例接受静脉组织型纤溶酶原激活物（tPA）后接受机械血栓切除术（如适用）和 3K3A-APC 或安慰剂治疗的 Safety Evaluation of 3K3A-APC in Ischemic Stroke（RHAPSODY）试验患者。使用磁共振成像（MRI）上的磁敏感加权序列（SWI）在第 2 天和第 7 天测量 ICH 体积。我们还计算了第 2 天和第 7 天之间的溶栓后 ICH 体积变化。通过使用 90 天时的效用加权改良 Rankin 量表（UW-mRS）来确定结局，通过使用 90 天时的效用加权改良 Rankin 量表（UW-mRS）来确定结局。为了尽量减少解释偏倚，结局评估者对治疗分配和临床数据均不知情。我们在多变量回归分析中调整了年龄、性别、国立卫生研究院卒中量表（NIHSS）评分（＜10、10-19 和≥20）、出血部位（单一基底节出血、单一脑叶、单一小脑和多个部位）。
110 例患者中共有 88 例（80%）发生溶栓后 ICH（平均体积 28.3ml ±62ml）。ICH 体积分层与 90 天时的 UW-mRS 无关：＜20cc（回归系数（RC）-0.05，p=0.58）、20-39cc（RC-0.22，p=0.17）或≥40cc（RC-0.34，p=0.083）与无 ICH 相比，调整潜在混杂因素后。第 2 天至第 7 天 ICH 平均体积变化 26.78ml ±59.68ml，52 例体积增加）与第 90 天的 UW-mRS 无关（RC-67.71，p=0.06）。
我们未观察到溶栓后 ICH 体积对急性缺血性脑卒中患者死亡或残疾有任何独立影响。尽管还需要进一步研究，但我们的数据表明，预防 ICH 扩大的策略，如抗纤维蛋白溶解药物和减少 ICH 体积，如手术清除，可能不会降低溶栓后 ICH 的急性缺血性脑卒中患者的死亡率或残疾率。
