Stroke:急性缺血性脑卒中患者血管内血栓切除术后造影剂诱发的脑病

2020-11-02 MedSci原创 MedSci原创

EVT后临床变现恶化并伴有造影剂染色和水肿变化的影像学证据的患者应怀疑CIE,尤其是肾功能不全或卒中病史的患者。

在急性缺血性卒中患者血管血栓切除术(EVT)后,造影剂诱发的脑病(CIE)是一种罕见且尚未被充分了解的并发症。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,这项研究调查了接受EVT的患者CIE的发生率和危险因素。

该研究纳入了2014年9月至2019年12月期间在2个医疗中心接受EVT的急性缺血性卒中患者。在梗死或出血性转化无法解释的情况下,手术后24小时内根据神经系统恶化或延迟改善的临床标准诊断出CIE,并且水肿变化的影像学标准超出了梗塞核心并伴有造影剂染色。

在421例接受EVT的急性缺血性卒中患者中,有7例(1.7%)患者发生了CIE,表现包括局灶性神经系统症状加重,昏迷和癫痫发作。与没有CIE的患者相比,CIE患者更有可能遭受造影剂诱发的急性肾损伤,但两组的造影剂剂量相当。CIE的独立危险因素包括肾功能不全(定义为估计的肾小球滤过率为45ml/min*1.73m2;比值比为5.77 [95%CI为1.37-24.3];P=0.02)和卒中史(比值比为4.96 [95%CI为1.15-21.3];P=0.03)。CIE患者获得良好的功能预后的可能性较小(比值比为0.09 [95%CI为0.01-0.87];P=0.04)。

由此可见,EVT后临床变现恶化并伴有造影剂染色和水肿变化的影像学证据的患者应怀疑CIE,尤其是肾功能不全或卒中病史的患者。

原始出处:

Yung-Tsai Chu,et al.Contrast-Induced Encephalopathy After Endovascular Thrombectomy for Acute Ischemic Stroke.stroke.2020.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031518

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createdBy=091e27733095, createdName=weihongyv, createdTime=Sat Feb 27 12:08:52 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807148, encodeId=5da9180e14819, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Sun Oct 10 21:08:52 CST 2021, time=2021-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720356, encodeId=07bf1e2035696, content=<a href='/topic/show?id=915c3604e6b' target=_blank 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GetPortalCommentsPageByObjectIdResponse(id=1666463, encodeId=c44d16664630e, content=<a href='/topic/show?id=55c6849451c' target=_blank style='color:#2F92EE;'>#脑病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84945, encryptionId=55c6849451c, topicName=脑病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db0126060584, createdName=showtest, createdTime=Fri May 21 04:08:52 CST 2021, time=2021-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=902168, encodeId=37c6902168b4, content=好像在造影禁忌症包括急性出血或者卒中的患者, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b80f5437667, createdName=ms5000000309834498, createdTime=Wed Nov 25 14:14:57 CST 2020, time=2020-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259414, encodeId=5bd81259414ea, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1314294, encodeId=14d6131429455, content=<a href='/topic/show?id=585189089f4' target=_blank style='color:#2F92EE;'>#血栓切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89089, encryptionId=585189089f4, topicName=血栓切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=284b425, createdName=zll0625, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401045, encodeId=abf5140104560, content=<a href='/topic/show?id=4a328909094' target=_blank style='color:#2F92EE;'>#血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89090, encryptionId=4a328909094, topicName=血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1877338, encodeId=f07318e73380c, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Wed Jul 14 08:08:52 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679151, encodeId=e5f716e915174, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Sat Feb 27 12:08:52 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807148, encodeId=5da9180e14819, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Sun Oct 10 21:08:52 CST 2021, time=2021-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720356, encodeId=07bf1e2035696, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Sun Dec 13 23:08:52 CST 2020, time=2020-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893332, encodeId=f66f1893332f9, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Thu Nov 19 02:08:52 CST 2020, time=2020-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1666463, encodeId=c44d16664630e, content=<a href='/topic/show?id=55c6849451c' target=_blank style='color:#2F92EE;'>#脑病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84945, encryptionId=55c6849451c, topicName=脑病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db0126060584, createdName=showtest, createdTime=Fri May 21 04:08:52 CST 2021, time=2021-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=902168, encodeId=37c6902168b4, content=好像在造影禁忌症包括急性出血或者卒中的患者, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b80f5437667, createdName=ms5000000309834498, createdTime=Wed Nov 25 14:14:57 CST 2020, time=2020-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259414, encodeId=5bd81259414ea, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1314294, encodeId=14d6131429455, content=<a href='/topic/show?id=585189089f4' target=_blank style='color:#2F92EE;'>#血栓切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89089, encryptionId=585189089f4, topicName=血栓切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=284b425, createdName=zll0625, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401045, encodeId=abf5140104560, content=<a href='/topic/show?id=4a328909094' target=_blank style='color:#2F92EE;'>#血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89090, encryptionId=4a328909094, topicName=血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1877338, encodeId=f07318e73380c, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Wed Jul 14 08:08:52 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679151, encodeId=e5f716e915174, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Sat Feb 27 12:08:52 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807148, encodeId=5da9180e14819, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Sun Oct 10 21:08:52 CST 2021, time=2021-10-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720356, encodeId=07bf1e2035696, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Sun Dec 13 23:08:52 CST 2020, time=2020-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893332, encodeId=f66f1893332f9, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Thu Nov 19 02:08:52 CST 2020, time=2020-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1666463, encodeId=c44d16664630e, content=<a href='/topic/show?id=55c6849451c' target=_blank style='color:#2F92EE;'>#脑病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84945, encryptionId=55c6849451c, topicName=脑病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db0126060584, createdName=showtest, createdTime=Fri May 21 04:08:52 CST 2021, time=2021-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=902168, encodeId=37c6902168b4, content=好像在造影禁忌症包括急性出血或者卒中的患者, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b80f5437667, createdName=ms5000000309834498, createdTime=Wed Nov 25 14:14:57 CST 2020, time=2020-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259414, encodeId=5bd81259414ea, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1314294, encodeId=14d6131429455, content=<a href='/topic/show?id=585189089f4' target=_blank style='color:#2F92EE;'>#血栓切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89089, encryptionId=585189089f4, topicName=血栓切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=284b425, createdName=zll0625, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401045, encodeId=abf5140104560, content=<a href='/topic/show?id=4a328909094' target=_blank style='color:#2F92EE;'>#血栓切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89090, encryptionId=4a328909094, topicName=血栓切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Wed Nov 04 03:08:52 CST 2020, time=2020-11-04, status=1, ipAttribution=)]
    2021-05-21 showtest
  7. 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    2020-11-25 ms5000000309834498

    好像在造影禁忌症包括急性出血或者卒中的患者

    0

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盘点:2020年度Radiology科研进展汇总(七)

Radiology:早期肝细胞肝癌切除后还会复发吗?

Stroke:急性缺血性脑卒中后白质高密度、降压治疗与功能结局

高WMH负荷的参与者在急性缺血性卒中后死亡或严重残疾的风险增加。早期抗高血压治疗对各种WMH严重程度的急性缺血性脑卒中患者临床结局的影响呈中性。

盘点:2020年度Radiology科研进展汇总(八)

2020年度Radiology科研进展汇总

Stroke:如何快速识别急性缺血性脑卒中后脑水肿?

脑卒中后短短数小时至数天就会出现脑水肿(CED),脑体积增加可能会导致中线偏移(MLS)及神经功能障碍。目前对于脑水肿形成过程及并发症并没有得到很好的探讨。

Stroke:识别急性脑桥梗死的神经功能障碍相关因素

关于急性脑桥梗死患者梗死灶形态与神经功能障碍间的关系尚不明确。本研究旨在识别急性脑桥梗死早期神经功能障碍(END)的形态学MRI预测指标。