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【文摘发布】急性卒中tPA溶栓后症状行颅内出血
Author：Lansberg MG, Thijs VN, Bammer R, Kemp S, Wijman CA, Marks MP, Albers GW; on behalf of The DEFUSE Investigators.
From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, Calif; and the Department of Neurology, University Hospitals of Leuven, Belgium.
Resource: Stroke. 2007 Jun 14; [Epub ahead of print]
Abstract：Background--Studies evaluating predictors of tPA-associated symptomatic intracerebral hemorrhage (SICH) have typically focused on clinical and CT-based variables. MRI-based variables have generally not been included in predictive models, and little is known about the influence of reperfusion on SICH risk. METHODS: Seventy-four patients were prospectively enrolled in an open-label study of intravenous tPA administered between 3 and 6 hours after symptom onset. An MRI was obtained before and 3 to 6 hours after tPA administration. The association between several clinical and MRI-based variables and tPA-associated SICH was determined using multivariate logistic regression analysis. SICH was defined as a >/=2 point change in National Institutes of Health Stroke Scale Score (NIHSSS) associated with any degree of hemorrhage on CT or MRI. Reperfusion was defined as a decrease in PWI lesion volume of at least 30% between baseline and the early follow-up MRI. RESULTS: SICH occurred in 7 of 74 (9.5%) patients. In univariate analysis, NIHSSS, DWI lesion volume, PWI lesion volume, and reperfusion status were associated with an increased risk of SICH (P<0.05). In multivariate analysis, DWI lesion volume was the single independent baseline predictor of SICH (odds ratio 1.42; 95% CI 1.13 to 1.78 per 10 mL increase in DWI lesion volume). When early reperfusion status was included in the predictive model, the interaction between DWI lesion volume and reperfusion status was the only independent predictor of SICH (odds ratio 1.77; 95% CI 1.25 to 2.50 per 10 mL increase in DWI lesion volume). CONCLUSIONS: Patients with large baseline DWI lesion volumes who achieve early reperfusion appear to be at greatest risk of SICH after tPA therapy.
PMID: 17569874
如果DWI上缺血面积过大还有溶栓的价值吗？ 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-09 17:11
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