Use of MRI to predict symptomatic haemorrhagic transformation after thrombolysis for cerebral ischaemia.
Adult
Aged
Aged, 80 and over
Brain
/ diagnostic imaging
Brain Ischemia
/ drug therapy
Cerebral Hemorrhage
/ chemically induced
Female
Fibrinolytic Agents
/ adverse effects
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Stroke
/ drug therapy
Thrombolytic Therapy
/ adverse effects
Tissue Plasminogen Activator
/ adverse effects
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
21
08
2019
revised:
14
01
2020
accepted:
16
01
2020
pubmed:
6
2
2020
medline:
18
8
2020
entrez:
5
2
2020
Statut:
ppublish
Résumé
Predictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors. We analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination. Of 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm Although the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT.
Sections du résumé
BACKGROUND AND OBJECTIVE
Predictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors.
METHOD
We analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination.
RESULTS
Of 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm
CONCLUSION
Although the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT.
Identifiants
pubmed: 32015090
pii: jnnp-2019-321904
doi: 10.1136/jnnp-2019-321904
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Banques de données
ClinicalTrials.gov
['NCT01614080']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
402-410Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: ND-P and HH reports participation in drug trials with Boehringer-Ingelheim (honoraria paid to the hospital). CC reports participation in symposia organised by Boehringer-Ingelheim and Pfizer, advisory board by BMS (honoraria paid to ADRINORD), drug trials with Boehringer-Ingelheim, Servier, Astra-Zeneca, Biogen (honoraria paid to the hospital), vice president of the European Stroke Organisation (unpaid), member of DSMBs for institutional trials (unpaid): ATTEST 2 (UK), FIV-HeMA (France). Research support from the French Ministry of Health (A3ICH). DL reports participation in symposia organised by Boehringer Ingelheim, Bayer, BMS and Pfizer (honoraria paid to Adrinord), drug trials with Boehringer-Ingelheim (honoraria paid to the hospital), vice editor of the European Stroke Journal (honoraria paid to Adrinord), vice president of the scientific committee of the Fondation de Recherche sur les AVC (unpaid) and member of the scientific committee of the Servier Institute (unpaid). Member of DSMBs for institutional trials (unpaid): INCH (Germany), TARDIS (UK), and TO-ACT (the Netherlands). Research support from a grant of the University of Heidelberg (Germany) for the ECASS4 trial.