Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion

被引:126
作者
Morotti, Andrea [1 ,3 ]
Boulouis, Gregoire [3 ,5 ]
Romero, Javier M. [1 ,2 ,3 ]
Brouwers, H. Bart [6 ]
Jessel, Michael J. [3 ]
Vashkevich, Anastasia [3 ]
Schwab, Kristin [3 ]
Afzal, Mohammad Rauf [7 ]
Cassarly, Christy [8 ]
Greenberg, Steven M. [3 ]
Martin, Renee Hebert [8 ]
Qureshi, Adnan I. [7 ]
Rosand, Jonathan [3 ]
Goldstein, Joshua N. [1 ,3 ,4 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Div Neurocrit Care & Emergency Neurol, Boston, MA 02115 USA
[2] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Serv Neuroradiol, Boston, MA USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, JP Kistler Stroke Res Ctr, Boston, MA USA
[4] Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA USA
[5] Univ Paris 05, Dept Neuroradiol, Ctr Hosp St Anne, DHU Neurovasc,INSERM S894, Paris, France
[6] Rudolf Magnus Univ Med Ctr, Brain Ctr, Dept Neurosurg, Utrecht, Netherlands
[7] Univ Minnesota, Zeenat Qureshi Stroke Res Ctr, Minneapolis, MN USA
[8] Med Univ South Carolina, Dept Publ Hlth Sci, Charleston, SC USA
关键词
PREDICTING HEMATOMA EXPANSION; ANGIOGRAPHY SPOT SIGN; COMPUTED-TOMOGRAPHY; BLEND SIGN; GROWTH; TRIAL; SCORE; ICH;
D O I
10.1212/WNL.0000000000004210
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To validate various noncontrast CT (NCCT) predictors of hematoma expansion in a large international cohort of ICH patients and investigate whether intensive blood pressure (BP) treatment reduces ICH growth and improves outcome in patients with these markers. Methods: We analyzed patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized controlled trial. Participants were assigned to intensive (systolic BP <140 mm Hg) vs standard (systolic BP <180 mm Hg) treatment within 4.5 hours from onset. The following NCCT markers were identified: intrahematoma hypodensities, black hole sign, swirl sign, blend sign, heterogeneous hematoma density, and irregular shape. ICH expansion was defined as hematoma growth >33% and unfavorable outcome was defined as modified Rankin Scale score >3 at 90 days. Logistic regression was used to identify predictors of ICH expansion and explore the association between NCCT signs and clinical benefit from intensive BP treatment. Results: A total of 989 patients were included (mean age 62 years, 61.9% male), of whom 186/869 experienced hematoma expansion (21.4%) and 361/952 (37.9%) had unfavorable outcome. NCCT markers independently predicted ICH expansion (all p, 0.01) with overall accuracy ranging from 61% to 78% and good interrater reliability (k. 0.6 for all markers). There was no evidence of an interaction between NCCT markers and benefit from intensive BP reduction (all p for interaction.0.10). Conclusions: NCCT signs reliably identify ICH patients at high risk of hematoma growth. However, we found no evidence that patients with these markers specifically benefit from intensive BP reduction.
引用
收藏
页码:548 / 554
页数:7
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