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

作　　者：Simiao Wu Grant Mair Geoff Cohen Zoe Morris Anders von Heijne Nick Bradey Lesley Cala Andre Peeters Andrew J Farrall Alessandro Adami Gillian Potter Ming Liu Richard I Lindley Peter A G Sandercock Joanna M Wardlaw the IST-3 Collaborative Group 

机构地区：[1]Department of Neurology,West China Hospital,Sichuan University,Chengdu,Sichuan,China [2]Centre for Clinical Brain Sciences,The University of Edinburgh,Edinburgh,UK [3]Department of Clinical Sciences,Danderyd Hospital,Stockholm,Sweden [4]Neuroradiology,James Cook University Hospital,South Tees Hospital NHS Trust,Middlesbrough,UK [5]Division of Pathology and Laboratory Medicine,School of Medicine,The University of Western Australia,Perth,Western Australia,Australia [6]Department of Neurology,Cliniques universitaires Saint-Luc,Bruxelles,Belgium [7]Stroke Center,IRCCS Sacro Cuore Don Calabria,Verona,Italy [8]Department of Neuroradiology,Manchester Centre for Clinical Neurosciences,Salford Royal NHS Foundation Trust,Salford,UK [9]Westmead Applied Research Centre,Westmead Clinical School,The University of Sydney,Sydney,New South Wales,Australia [10]The George Institute for Global Health,Newtown,New South Wales,Australia [11]UK Dementia Research Institute Centre at the University of Edinburgh,Edinburgh,United Kingdom [12]不详

出　　处：《Stroke & Vascular Neurology》2021年第2期238-243,共6页卒中与血管神经病学（英文）

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 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.Methods 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.Results 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.

关 键 词：INFARCT SWELLING EFFECT 

分 类 号：R743.3[医药卫生—神经病学与精神病学]