Neurology Department, faculty of medicine, Kafr El-sheikh university, Elgeish street, Kafr el-sheikh, Egypt.
Neurology Department, faculty of medicine, Al-Azhar university, ELmokhaim St., Cairo, Egypt.
Sci Rep. 2024 Nov 30;14(1):29822. doi: 10.1038/s41598-024-76189-0.
Worldwide, stroke is a leading cause of long-term disability in adults. Alteplase is the only approved treatment for acute ischemic stroke (AIS) and results in an improvement in a third of treated patients. Most studies evaluated the post-alteplase haemorrhagic transformation of brain infarction as a homogeneous entity but we evaluated the predictors of each subtype of haemorrhagic transformation of brain infarction. Our trial included 616 AIS alteplase-treated patients. We evaluated the ability of different risk factors, clinical presentation, and imaging features to predict different haemorrhagic transformation (HT) subtypes. HT was seen in 152 patients (24.7%), higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction, in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 (odds ratio [OR], 11.04; 95% CI, 9.81 to 12.70; P-value > 0.001) and type2 (OR, 11.89; 95% CI, 9.79 to 14.44; P-value > 0.001), while older age was also an independent predictor of parenchymal hematoma type1 (OR, 1.312; 95% CI, 1.245 to 1.912; P-value 0.02). In AIS patients treated with alteplase in Egypt and Saudi Arabia, higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction; in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 and 2, while older age was also an independent predictor of parenchymal hematoma type1. Trial registration: (clinicaltrials.gov NCT06337175), retrospectively registered on 29/03/2024.
在全球范围内，中风是成年人长期残疾的主要原因。阿替普酶是急性缺血性中风（AIS）的唯一批准治疗方法，可使三分之一的接受治疗的患者病情得到改善。大多数研究将溶栓后脑梗死的出血性转化评估为同质实体，但我们评估了脑梗死出血性转化的每种亚型的预测因素。我们的试验纳入了 616 例 AIS 阿替普酶治疗患者。我们评估了不同危险因素、临床表现和影像学特征对不同出血性转化（HT）亚型的预测能力。152 例（24.7%）患者出现 HT，较高的 NIHSS、心源性栓塞性中风和心房颤动是所有基于 ECASS 的出血性梗死亚型的独立预测因素，此外，前循环中风是出血性梗死 1 型（比值比 [OR]，11.04；95%置信区间，9.81 至 12.70；P 值>0.001）和 2 型（OR，11.89；95%置信区间，9.79 至 14.44；P 值>0.001）的独立预测因素，而年龄较大也是 1 型实质血肿的独立预测因素（OR，1.312；95%置信区间，1.245 至 1.912；P 值 0.02）。在埃及和沙特阿拉伯接受阿替普酶治疗的 AIS 患者中，较高的 NIHSS、心源性栓塞性中风和心房颤动是所有基于 ECASS 的出血性梗死亚型的独立预测因素；此外，前循环中风是出血性梗死 1 型和 2 型的独立预测因素，而年龄较大也是 1 型实质血肿的独立预测因素。试验注册：（clinicaltrials.gov NCT06337175），于 2024 年 3 月 29 日进行回顾性注册。
