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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction
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Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction

机译：电脑断层纤溶酶原激活剂的安全性和计算机X线断层扫描显示先前梗死的证据

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Background Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA). Methods We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition. Results Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P =.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P =.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P =.221) or any HT (18% versus 14%; P =.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P <.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P =.065). Conclusions Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.
机译：背景3个月以内的中风使患者无法进行溶栓治疗;但是，患者可能具有计算机X线断层扫描（CT）证据，表明先前有梗塞，通常不知道起源时间。我们旨在确定在进行静脉内（IV）组织纤溶酶原激活剂（tPA）给药后，CT上是否存在先前的梗死是出血并发症和功能预后的预测指标。方法回顾性分析我院2009年至2011年连续接受静脉tPA治疗的患者。对治疗前的CT进行了检查，以寻找任何先前的梗塞证据。进一步的检查确定在重复CT或磁共振成像中是否存在任何出血性转化（HT）或症状性脑出血（sICH）。结果包括sICH，任何HT，功能预后不良（改良的Rankin Scale评分为4-6）和出院倾向。结果在212例接受IV tPA治疗的患者中，有84例（40％）有在CT治疗前有梗塞迹象的证据。先前有CT梗死的患者年龄较大（中位年龄为72岁至65岁; P = .001），并且在美国国立卫生研究院卒中量表评分较高（中位分别为10对7; P = .023）。先前有CT梗死的患者没有更多的sICH（4％比2％; P = .221）或任何HT（18％比14％; P = .471）。这些患者出院时确实出现较差的功能预后的频率更高（82％比50％; P <.001），出院或住院康复中心的频率更低（61％比73％; P = .065）。结论在我们的研究中，可视化的治疗前CT既往梗死并不能预测sICH的风险增加，并且不应被视为排除3个月内临床上明显的中风后停止全身性tPA治疗的原因。

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