医学
优势比
溶栓
冲程(发动机)
置信区间
血运重建
内科学
脑出血
病变
外科
蛛网膜下腔出血
心肌梗塞
机械工程
工程类
作者
Jean‐Philippe Desilles,Aymeric Rouchaud,Julien Labreuche,Elena Meseguer,Jean-Pierre Laissy,Jean-Michel Serfaty,Bertrand Lapergue,Isabelle Klein,Céline Guidoux,Lucie Cabrejo,Silvia Gaia,Philippa C. Lavallée,É. Schouman-Claeys,Pierre Amarenco,Mikaël Mazighi
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2013-02-26
卷期号:80 (9): 844-851
被引量:85
标识
DOI:10.1212/wnl.0b013e31828406de
摘要
To evaluate the incidence, baseline characteristics, and clinical prognosis of blood-brain barrier (BBB) disruption after endovascular therapy in acute ischemic stroke patients.A total of 220 patients treated with endovascular therapy between April 2007 and October 2011 were identified from a prospective, clinical, thrombolysis registry. All patients underwent a nonenhanced CT scan immediately after treatment. CT scan or MRI was systematically realized at 24 hours to assess intracranial hemorrhage complications. BBB disruption was defined as a hyperdense lesion on the posttreatment CT scan.BBB disruption was found in 128 patients (58.2%; 95% confidence interval [CI], 51.4%-64.9%). Cardioembolic etiology, high admission NIH Stroke Scale score, high blood glucose level, internal carotid artery occlusion, and use of combined endovascular therapy (chemical and mechanical revascularization) were independently associated with BBB disruption. Patients with BBB disruption had lower rates of early major neurologic improvement (8.6% vs 31.5%, p < 0.001), favorable outcome (39.8% vs 61.8%, p = 0.002), and higher rates of 90-day mortality (34.4% vs 14.6%, p = 0.001) and hemorrhagic complications (42.2% vs 8.7%, p < 0.001) than those without BBB disruption. By multivariable analysis, patients with BBB disruption remained with a lower rate of early neurologic improvement (adjusted odds ratio [OR], 0.28; 95% CI, 0.11-0.70) and with a higher rate of mortality (adjusted OR, 2.37; 95% CI, 1.06-5.32) and hemorrhagic complications (adjusted OR, 6.38; 95% CI, 2.66-15.28).BBB disruption has a detrimental effect on outcome and is independently associated with mortality after endovascular therapy. BBB disruption assessment may have a role in prognosis staging in these patients.
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