Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke
作者机构：Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina Centre for Clinical Brain SciencesThe University of EdinburghEdinburghUK Department of Clinical SciencesDanderyd HospitalStockholmSweden NeuroradiologyJames Cook University HospitalSouth Tees Hospital NHS TrustMiddlesbroughUK Division of Pathology and Laboratory MedicineSchool of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia Department of NeurologyCliniques universitaires Saint-LucBruxellesBelgium Stroke CenterIRCCS Sacro Cuore Don CalabriaVeronaItaly Department of NeuroradiologyManchester Centre for Clinical NeurosciencesSalford Royal NHS Foundation TrustSalfordUK Westmead Applied Research CentreWestmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia The George Institute for Global HealthNewtownNew South WalesAustralia UK Dementia Research Institute Centre at the University of EdinburghEdinburghUnited Kingdom 不详
出 版 物：《Stroke & Vascular Neurology》 (卒中与血管神经病学（英文）)
年 卷 期：2021年第6卷第2期
页 面：238-243页
核心收录：
学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学]
基 金：the UK Medical Research Council(MRC G0400069 and EME-09-800-15) Other fundings are detailed in the Supplemental Material.SW acknowledges funding from the National Natural Science Foundation of China(81701156) GM acknowledges funding from the Stroke Association(SA L-SMP 18\1000) ML acknowledges funding from the Key Research and Development Program,Science&Technology Department of Sichuan Province(2017SZ0007) the Major International(Regional)Joint Research Project,National Natural Science Foundation of China(81620108009) the National Key Research and Development Program of China,Ministry of Science and Technology of China(2016YFC1300500-505) the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYGD18009) JMW acknowledges funding from the UK Dementia Research Institute(DRI Ltd:Medical Research Council,Alzheimer's Society and Alzheimer's Research UK),British Heart Foundation Centre for Research Excellence Award III(RE/18/5/34216) the Fondation Leducq(16 CVD 05)
摘 要：Background 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 *** 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 *** We included stroke patients whose prerandomisation scan was non-contrast ***,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 *** 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 *** 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).Conclusion 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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