Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial

作者：Candice Delcourt, Xia Wang, Zien Zhou, Joanna M. Wardlaw, Grant Mair, Thompson Robinson, Xiaoying Chen, Sohei Yoshimura, Takako Torii-Yoshimura, Cheryl Carcel, Zeljka Calic, Wee Yong Tan, Alejandra Malavera, Craig S Anderson, Richard I. Lindley · 发表于：Journal of Neurology Neurosurgery & Psychiatry · 年份：2020 · DOI：10.1136/jnnp-2020-323015 · 被引用次数：29 · 研究领域：Acute Ischemic Stroke Management、Dementia and Cognitive Impairment Research、Intracerebral and Subarachnoid Hemorrhage Research

OBJECTIVE: To test the hypothesis that imaging signs of 'brain frailty' and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED). METHODS: Blinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0-2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs. RESULTS: 2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5-14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect ...