Yokogami K, Nakano S, Ohta H, Goya T, Wakisaka S
Department of Neurosurgery, Junwakai Memorial Hospital, Junwa Foundation, Komatsu, Japan.
Neurosurgery. 1996 Dec;39(6):1102-7. doi: 10.1097/00006123-199612000-00006.
To evaluate the usefulness of pre- and post-therapeutic computed tomographic (CT) findings in predicting hemorrhagic complications, we retrospectively examined 35 patients treated with intra-arterial thrombolytic therapy for middle cerebral artery (MCA) occlusion.
The presence or absence of early CT findings (loss of the insular ribbon, obscuration of the lentiform nucleus, and cortical effacement) and the presence and location of extravasation of contrast medium were evaluated on pre- and post-therapeutic CT scans, respectively. According to the angiographic occlusive site, the patients were classified into the following three groups: Group 1 (n = 13), MCA trunk occlusion involved lenticulostriate arteries; Group 2 (n = 11), occlusion of the MCA trunk without involvement of the lenticulostriate arteries; Group 3 (n = 11), occlusion of a branch of the MCA. Hemorrhagic complications (hemorrhagic transformation and/or massive brain swelling) were evaluated by reviewing CT scans obtained 3 to 14 days after thrombolytic therapy.
No patient without extravasation (n = 17) showed hemorrhagic complications, and extravasation is the most useful finding in predicting hemorrhagic complications. There was significant correlation between extravasation and hemorrhagic complications (P < 0.01). In Groups 1 and 2, there was also significant correlation between early CT findings and hemorrhagic complications (P < 0.01), indicating that early CT findings are also useful in predicting hemorrhagic complications. In Group 1, 10 of 13 (76.9%) patients had both early CT findings and extravasation, and 6 of these 10 patients had hemorrhagic complications with clinical deterioration, suggesting the difficulty of thrombolytic therapy in this group. On the contrary, in Group 2, 8 of 11 (72.7%) patients had neither early CT findings nor extravasation and none of these 8 patients had hemorrhagic complications. In Group 3, however, early CT findings and extravasation had no correlation. Because the affected area was small in this group, it was difficult to evaluate cortical effacement. Although negative early CT findings did not always mean absence of extravasation and hemorrhagic complications in this group, the patients with hemorrhagic complications did not clinically deteriorate because of the small affected area.
Hemorrhagic complications could be predicted by evaluation of angiographic occlusive site and pre- and post-therapeutic CT findings.
为评估治疗前和治疗后的计算机断层扫描（CT）结果在预测出血性并发症方面的作用，我们回顾性研究了35例接受动脉内溶栓治疗大脑中动脉（MCA）闭塞的患者。
分别在治疗前和治疗后的CT扫描上评估早期CT表现（岛带消失、豆状核模糊和皮质变薄）的有无以及造影剂外渗的有无和位置。根据血管造影闭塞部位，将患者分为以下三组：第1组（n = 13），MCA主干闭塞累及豆纹动脉；第2组（n = 11），MCA主干闭塞不累及豆纹动脉；第3组（n = 11），MCA分支闭塞。通过回顾溶栓治疗后3至14天获得的CT扫描评估出血性并发症（出血转化和/或大面积脑肿胀）。
无造影剂外渗的患者（n = 17）均未出现出血性并发症，造影剂外渗是预测出血性并发症最有用的表现。造影剂外渗与出血性并发症之间存在显著相关性（P < 0.01）。在第1组和第2组中，早期CT表现与出血性并发症之间也存在显著相关性（P < 0.01），表明早期CT表现也有助于预测出血性并发症。在第1组中，13例患者中有10例（76.9%）既有早期CT表现又有造影剂外渗，这10例患者中有6例出现出血性并发症且临床病情恶化，提示该组溶栓治疗困难。相反，在第2组中，11例患者中有8例（72.7%）既无早期CT表现也无造影剂外渗，这8例患者均未出现出血性并发症。然而，在第3组中，早期CT表现与造影剂外渗无相关性。由于该组受累面积较小，难以评估皮质变薄情况。虽然该组早期CT表现阴性并不总是意味着无造影剂外渗和出血性并发症，但由于受累面积小，出现出血性并发症的患者临床病情未恶化。
通过评估血管造影闭塞部位以及治疗前和治疗后的CT表现可预测出血性并发症。
