RÉSUMÉ
Objective To compare the predictive value of 5 scoring systems for hemorrhagic transformation risk after intravenous thrombolysis in patients with acute ischemic stroke (AIS) in different therapeutic windows.Methods A single-center and retrospective study was performed for 243 AIS patients who underwent intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) in different therapeutic windows in our department during January 2014 and December 2016.Five scoring systems,including HAT model (hemorrhage after thrombolysis),MSS model (multicenter stoker survey),GRASPS model (glucose at presentation,race,age,sex,systolic blood pressure at presentation,severity of stroke at presentation),SEDAN model (baseline blood sugar,early infarct signs,hyperdense cerebral artery sign on admission CT,age,NIHSS on admission),and SITS model (safe implementation of thrombolysis in strokemonitoring study) were used to evaluate the risks for hemorrhagic transformation.The relationships between the 5 scoring systems and incidence rate of hemorrhagic transformation were analyzed among the patients in different therapeutic windows.The predictive values of the 5 scoring systems were compared using the areas (AUC) under the receiver operating characteristic (ROC) curve.Results When the AIS patients were treated by intravenous thrombolysis within 3 h,the AUC of GRASPS and HAT models were 0.698 and 0.619,respectively,higher than those of the other 3 systems.When the therapeutic window was between 3 to 4.5 h,HAT model and SEDAN model had highest AUC (0.719,0.744) than the other 3 systems (P ＜0.05).When the windows were ＞4.5 ～6 h,the HAT model had the highest AUC (0.676).Conclusion The 5 scoring systems show better predictive value for hemorrhagic transformation after intravenous thrombolysis.For the therapeutic window within 4.5 h,HAT model presents best predictive value than the other 4 scoring systems.
RÉSUMÉ
Objective To investigate the imaging changeof cerebral ischemireperfusion injury (CIRI) afteinterventional therapy in acute middle cerebral artery occlusion .Method32 patientwith acute middle cerebral artery occlusion in ouhospital from January 2013 to Novembe2014 were selected .16 casewere performed the recanalization therapy aftearterial thrombolysiand/omechanical thrombectomy(recanalization group) and 16 casewere notreated by thrombolytitherapy (non-recanalization group) .The differenceof brain imaging changes(onse,on 3 ,7 d afteonset) were analyzed and compared between the two group. ResultThe proportion of lateral ventricle compression degree and the shifdegree of brain midline on 3 d afteonsein the reca-nalization group were greatethan those in the non-recanalization group ,the differencebetween the two groupwere statistically significant[0 .50 ± 0 .11 v.0 .58 ± 0 .10 ,0 .57(0 .18 ,0 .83)cm v.0 .22(0 ,0 .57)cm ,P＜0 .05] ,while which on 7 d of onsein the recanalization group were lesthan those in the non-recanalization group[0 .80 ± 0 .11 v.0 .55 ± 0 .12 ,0(0 ,0 .13) v.0 .46(0 , 0 .88)cm ,P＜0 .055] .Conclusion Although the interventional therapy ian importanmeasure foearly treatmenof ischemistroke ,buiaggravatethe early brain edem,therefore CIRI induced by the interventional therapy should be paid more attention to.