Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke

医学 冲程(发动机) 肿胀 的 内科学 心脏病学 脑肿胀 不利影响 放射科 外科 病理 机械工程 工程类
作者
Simiao Wu,Grant Mair,Geoff Cohen,Zoe Morris,Anders von Heijne,Nick Bradey,L.A. Cala,André Peeters,Andrew Farrall,Alessandro Adami,Gillian Potter,Ming Liu,Richard I Lindley,Peter Sandercock,Joanna M. Wardlaw
出处
期刊:Stroke and vascular neurology [BMJ]
卷期号:6 (2): 238-243 被引量:5
标识
DOI:10.1136/svn-2020-000569
摘要

Alteplase improves functional outcomes of patients with acute ischaemic stroke, but its effects on symptomatic infarct swelling, an adverse complication of stroke and the influence of CT hyperdense artery sign (HAS) are unclear. This substudy of the Third International Stroke Trial aimed to investigate the association between HAS and symptomatic infarct swelling and effect of intravenous alteplase on this association.We included stroke patients whose prerandomisation scan was non-contrast CT. Raters, masked to clinical information, assessed baseline (prerandomisation) and follow-up (24-48 hours postrandomisation) CT scans for HAS, defined as an intracranial artery appearing denser than contralateral arteries. Symptomatic infarct swelling was defined as clinically significant neurological deterioration ≤7 days after stroke with radiological evidence of midline shift, effacement of basal cisterns or uncal herniation.Among 2961 patients, HAS presence at baseline was associated with higher risk of symptomatic infarct swelling (OR 2.21; 95% CI 1.42 to 3.44). Alteplase increased the risk of swelling (OR 1.69; 95% CI 1.11 to 2.57), with no difference between patients with and those without baseline HAS (p=0.49). In patients with baseline HAS, alteplase reduced the proportion with HAS at follow-up (OR 0.67; 95% CI 0.50 to 0.91), where HAS disappearance was associated with reduced risk of swelling (OR 0.25, 95% CI 0.14 to 0.47).Although alteplase was associated with increased risk of symptomatic infarct swelling in patients with or without baseline HAS, it was also associated with accelerated clearance of HAS, which in return reduced swelling, providing further mechanistic insights to underpin the benefits of alteplase.
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