静脉溶栓治疗后并发远隔部位有症状颅内出血的急性缺血性卒中患者的临床特征和转归

Clinical features and outcomes in acute ischemic stroke patients with remote symptomatic intracranial hemorrhage after intravenous thrombolysis

目的探讨静脉溶栓后远隔部位有症状颅内出血（remote symptomatic intracranial hemorrhage，sICnr）的急性缺血性卒中患者临床特征和转归。方法回顾性纳入静脉溶栓治疗后sICHr的急性缺血性卒中患者，收集其临床资料并结合文献进行分析和总结。结果共纳入6例静脉溶栓治疗后发生sICHr的急性缺血性卒中患者，其中4例为男性，3例有抗血小板药使用史，2例伴有心房颤动，4例有高血压，3例有既往卒中史，4例有吸烟史，4例在静脉溶栓后2h内发生。在总共14个出血灶中（除外梗死区出血），10个出现在大脑皮质区。3例在t周内死亡，1例呈植物状态。结论急性缺血性卒中患者静脉溶栓后sICHr多位于大脑皮质。静脉溶栓后sICHr的急性缺血性卒中患者转归差，病死率高。

Objective To investigate clinical features and outcomes in acute ischemic stroke patients with remote symptomatic intracranial hemorrhage （slCHr） after intravenous thrombolysis. Methods The acute ischemic stroke patients with slCHr after intravenous thrombolysis therapy were enrolled retrospectively. The clinical data were collected and the related literature was analyzed and summarized. Results A total of 6 acute ischemic stroke patients with slCHr were enrolled, including 4 males. Three patients had a history of using antiplatelet agents, 2 with atrial fibrillation, 4 with hypertension, 3 with previous stroke history, 4 with smoking history, and 4 had slCHr at 2 h after intravenous thrombolysis. Of the 14 hemorrhagic foci （except in the infarct areas）, 10 were in the cerebral cortex. Three patients died within 1 week, and 1 was in a persistent vegetative state. Conclusions SICHr after intravenous thrombolysis in patients with acute ischemic stroke is mainly located in the cerebral cortex. The outcomes in acute ischemic stroke patients with SICHr after intravenous thrombolysis are poor, and the mortality is high.