Zhu X L, Chan M S, Poon W S
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Stroke. 1997 Jul;28(7):1406-9. doi: 10.1161/01.str.28.7.1406.
In spontaneous intracerebral hemorrhage (ICH), the site, age of the patients, and preexisting hypertension are important factors in determining the possibility of finding an underlying vascular abnormality by cerebral angiography. To what extent these three factors affect the indication for angiography remains controversial. A prospective study was carried out to correlate the angiographic findings with these three factors.
Two hundred six consecutive spontaneous ICH cases with an age range from 5 to 79 years (median, 45) were investigated with CT and cerebral angiography over a 3-year period (April 1993 through March 1996). Exclusion criteria were (1) poor surgical risk or severely neurologically disabled patients, (2) refusal of angiography, (3) patients in whom severe coagulopathy accounted for the hemorrhage, (4) bleeding into tumor, or (5) subarachnoid hemorrhage-predominant cases.
Angiographic yield (the frequency of positive angiography in a defined patient group) was significantly higher in patients (1) at or below the median age of 45 than those above (53/105, 50%, versus 18/101, 18%; P < .001) and (2) without preexisting hypertension than those with (64/145, 44%, versus 5/58, 9%; P < .001). The correlation of age and preexisting hypertension to angiographic yield was independent (logistic regression coefficients -0.056 and -1.59 and SE 0.12 and 0.515, respectively, both P < .001). In patients of the younger age group without preexisting hypertension, angiographic yield was 48% in putaminal, thalamic, or posterior fossa ICH and 65% in lobar ICH. In the older hypertensive patients, the yields were 0% and 10%, respectively. However, in patients with isolated intraventricular hemorrhage, most were normotensive and the yield was high in both age groups (67% versus 63%).
Diagnostic cerebral angiography should be considered for all spontaneous ICH patients except those over 45 years old with preexisting hypertension in thalamic, putaminal, or posterior fossa hemorrhage.
在自发性脑出血（ICH）中，出血部位、患者年龄以及既往高血压史是决定通过脑血管造影发现潜在血管异常可能性的重要因素。这三个因素在多大程度上影响血管造影的指征仍存在争议。开展了一项前瞻性研究以将血管造影结果与这三个因素相关联。
在3年期间（1993年4月至1996年3月），对206例年龄在5至79岁（中位数为45岁）的连续自发性ICH病例进行了CT和脑血管造影检查。排除标准为：（1）手术风险差或神经功能严重残疾的患者；（2）拒绝血管造影；（3）严重凝血功能障碍导致出血的患者；（4）肿瘤内出血；或（5）以蛛网膜下腔出血为主的病例。
血管造影阳性率（在特定患者组中血管造影阳性的频率）在以下患者中显著更高：（1）年龄在45岁及以下的患者高于45岁以上的患者（53/105，50%，对比18/101，18%；P <.001）；（2）无既往高血压史的患者高于有既往高血压史的患者（64/145，44%，对比5/58，9%；P <.001）。年龄和既往高血压史与血管造影阳性率的相关性是独立的（逻辑回归系数分别为 -0.056和 -1.59，标准误分别为0.12和0.515，P均 <.001）。在年龄较小且无既往高血压史的患者中，壳核、丘脑或后颅窝ICH的血管造影阳性率为48%，脑叶ICH为65%。在年龄较大的高血压患者中，阳性率分别为0%和10%。然而，在孤立性脑室内出血患者中，大多数血压正常，两个年龄组的阳性率都很高（67%对比63%）。
除45岁以上有丘脑、壳核或后颅窝出血且有既往高血压史的自发性ICH患者外，所有自发性ICH患者均应考虑进行诊断性脑血管造影。
