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Use of Noncontrast Computed Tomography and Computed Tomographic Perfusion in Predicting Intracerebral Hemorrhage After Intravenous Alteplase Therapy.
Batchelor, Connor; Pordeli, Pooneh; d'Esterre, Christopher D; Najm, Mohamed; Al-Ajlan, Fahad S; Boesen, Mari E; McDougall, Connor; Hur, Lisa; Fainardi, Enrico; Shankar, Jai Jai Shiva; Rubiera, Marta; Khaw, Alexander V; Hill, Michael D; Demchuk, Andrew M; Sajobi, Tolulope T; Goyal, Mayank; Lee, Ting-Yim; Aviv, Richard I; Menon, Bijoy K.
Afiliação
  • Batchelor C; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Pordeli P; Guest Editor for this article was Natan M. Bornstein, MD.
  • d'Esterre CD; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Najm M; Guest Editor for this article was Natan M. Bornstein, MD.
  • Al-Ajlan FS; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Boesen ME; Guest Editor for this article was Natan M. Bornstein, MD.
  • McDougall C; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Hur L; Guest Editor for this article was Natan M. Bornstein, MD.
  • Fainardi E; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Shankar JJS; Guest Editor for this article was Natan M. Bornstein, MD.
  • Rubiera M; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Khaw AV; Guest Editor for this article was Natan M. Bornstein, MD.
  • Hill MD; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Demchuk AM; Guest Editor for this article was Natan M. Bornstein, MD.
  • Sajobi TT; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Goyal M; Guest Editor for this article was Natan M. Bornstein, MD.
  • Lee TY; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
  • Aviv RI; Guest Editor for this article was Natan M. Bornstein, MD.
  • Menon BK; From the Calgary Stroke Program, Department of Clinical Neurosciences (P.P., C.D.d., M.N., F.S.A.-A., C.M., L.H., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d., M.D.H., A.M.D., M.G., T.-Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), an
Stroke ; 48(6): 1548-1553, 2017 06.
Article em En | MEDLINE | ID: mdl-28446625
ABSTRACT
BACKGROUND AND

PURPOSE:

Intracerebral hemorrhage is a feared complication of intravenous alteplase therapy in patients with acute ischemic stroke. We explore the use of multimodal computed tomography in predicting this complication.

METHODS:

All patients were administered intravenous alteplase with/without intra-arterial therapy. An age- and sex-matched case-control design with classic and conditional logistic regression techniques was chosen for analyses. Outcome was parenchymal hemorrhage on 24- to 48-hour imaging. Exposure variables were imaging (noncontrast computed tomography hypoattenuation degree, relative volume of very low cerebral blood volume, relative volume of cerebral blood flow ≤7 mL/min·per 100 g, relative volume of Tmax ≥16 s with all volumes standardized to z axis coverage, mean permeability surface area product values within Tmax ≥8 s volume, and mean permeability surface area product values within ipsilesional hemisphere) and clinical variables (NIHSS [National Institutes of Health Stroke Scale], onset to imaging time, baseline systolic blood pressure, blood glucose, serum creatinine, treatment type, and reperfusion status).

RESULTS:

One-hundred eighteen subjects (22 patients with parenchymal hemorrhage versus 96 without, median baseline NIHSS score of 15) were included in the final analysis. In multivariable regression, noncontrast computed tomography hypoattenuation grade (P<0.006) and computerized tomography perfusion white matter relative volume of very low cerebral blood volume (P=0.04) were the only significant variables associated with parenchymal hemorrhage on follow-up imaging (area under the curve, 0.73; 95% confidence interval, 0.63-0.83). Interrater reliability for noncontrast computed tomography hypoattenuation grade was moderate (κ=0.6).

CONCLUSIONS:

Baseline hypoattenuation on noncontrast computed tomography and very low cerebral blood volume on computerized tomography perfusion are associated with development of parenchymal hemorrhage in patients with acute ischemic stroke receiving intravenous alteplase.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tomografia Computadorizada por Raios X / Hemorragia Cerebral / Circulação Cerebrovascular / Ativador de Plasminogênio Tecidual / Acidente Vascular Cerebral / Fibrinolíticos Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tomografia Computadorizada por Raios X / Hemorragia Cerebral / Circulação Cerebrovascular / Ativador de Plasminogênio Tecidual / Acidente Vascular Cerebral / Fibrinolíticos Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article