静脉溶栓后的远隔出血效应

1、Stroke. 2016 Aug;47(8)2016-8-18 Quan DongBackgroundIntracerebral hemorrhage (ICH) is the most serious complication of intravenous thrombolysis with recombinant tissue-type plasminogen activator (IV-r-tPA) in patients with ischemic stroke.Remote Parenchymal Hemorrhages（rPH） has an incidence of 1.3 to

2、 3.7% and is associated with a poor outcomeLittle is known about the frequency, associated risk factors, and prognosis of rPH.The aim of this study was to analyze frequency, risk factors, clinical and radiological features, and prognosis of patients with rPH.MethodsMethods (Study Population)Methods

3、(Clinical Assessment)The following variables were recorded: Demographicstraditional vascular risk factors liver disease previous medicationtime from the onset of symptoms to the administration of IV-r-tPA NIHSSscore at admission and 24 to 36 hours hypertensive episodes and hyperthermia ; baseline la

4、boratory data type of hemorrhagic complication , number and localization rPH; TOAST symptomatic ICH functional outcome and mortality were assessed at 3 months (Rankin scale score 2).人口学特征血管危险因素肝脏疾病既往用药溶栓时间NIHSS评分血压及体温基线实验室数据出血并发症类型，rPH部位和数量TOAST分型症状性脑出血功能预后Methods (Radiological Assessment)MRI1.5TT1T

5、2FLAIRT2*DWIRSI （ recent silent ischemia ）LeukoaraiosisCMB（ cerebral microbleeds ）CSS（ cortical superficial siderosis ） Vascular malformationsMethods (Statistical Analysis)ischemic stroke IV-r-tPA rPH group Single or multiple rPH rPH + concomitant PHPH groupwithout any rPH or PHNo bleeding indicates

6、 hemorrhagic infarctMethods (Statistical Analysis)Statistical Analysiscontingency tables with the 2 or the Fisher exact test Student t test for quantitative variables MannWhitney U test multiple logistic regression analysis ResultsDistribution of Bleeding Complications Risk Factors Clinical and Radi

7、ological FeaturesRisk Factors in the Whole SampleDemographic variables, traditional vascular risk factors, previous treatments, time from the onset of symptoms to the administration of IV-r-tPA, initial NIHSS score, vital signs, laboratory findings, and pathogenesis were not different between patien

8、ts with rPH and those without any rPH or PHRisk Factors in Patients With MRIPrognosisDiscussionQ: frequencyIn this multicenter study, we observed that 3.4% patients had a rPH that is comparable to the rates reported in previous clinical trials (1.33.7%). Q: pathogenesis etiologyThe most remarkable f

9、inding in this study is that strictly lobar CMB, which appear to be indicative of CAA-related vasculopathy, and multiple acute embolic ischemic lesions are associated with rPH.Q: PrognosisIt is clear that patients with rPH have higher rates of early neurological deterioration, 3 months functional ep

10、endence, and mortality compared with patients without any rPH or PH.Limitationsour study was retrospective even though case ascertainment and entry of some basic information into the registry were prospective.We decided to exclude patients without basic clinical or radiological data. Thus, the numbe

11、r of patients in this study was reduced.a possible sample selection biasour model has only been tested in the data set from which it was derived. It has not been prospectively validated with independent dataMRI data were reviewed retrospectively by different investigators without any inter-rater var

12、iability analyses. both CMB and CSS may be mimicked by other tructural lesions.most MRI were performed after IV-r-tPA.SummaryWe have shown that rPH is a relatively uncommon complication of intravenous thrombolysis that increases the risk of poor neurological outcome and mortality.Our findings suppor

13、t an association between this complication and CAA and ischemic damage in different regions. Future studies are needed Thank you for your attentionDefinition Remote Parenchymal Hemorrhages（rPH）The European Cooperative Acute Stroke Study (ECASS) single or multiple hemorrhages that appear in brain regions without visible ischemic damage detected by cranial computed tomography (CT), remote from the area causing the initial stroke symptoms.Recent Silent Ischemia （ RSI ）one or