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Titolo:
Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort
Autore:
Fiorelli, M; Bastianello, S; von Kummer, R; del Zoppo, GJ; Larrue, V; Lesaffre, E; Ringleb, AP; Lorenzano, S; Manelfe, C; Bozzao, L;
Indirizzi:
Univ La Sapienza, Dept Neurol Sci, I-00185 Rome, Italy Univ La Sapienza Rome Italy I-00185 Dept Neurol Sci, I-00185 Rome, Italy Univ Dresden, Dept Neuroradiol, Dresden, Germany Univ Dresden Dresden Germany resden, Dept Neuroradiol, Dresden, Germany Scripps Res Inst, Dept Mol & Expt Med, La Jolla, CA USA Scripps Res Inst La Jolla CA USA , Dept Mol & Expt Med, La Jolla, CA USA Univ Toulouse, Dept Neurol, Toulouse, France Univ Toulouse Toulouse France v Toulouse, Dept Neurol, Toulouse, France Univ Louvain, Biostat Ctr Clin Trials, B-3001 Louvain, Belgium Univ Louvain Louvain Belgium B-3001 Clin Trials, B-3001 Louvain, Belgium Univ Heidelberg, Dept Neurol, Heidelberg, Germany Univ Heidelberg Heidelberg Germany rg, Dept Neurol, Heidelberg, Germany Univ Toulouse, Dept Neuroradiol, Toulouse, France Univ Toulouse ToulouseFrance louse, Dept Neuroradiol, Toulouse, France
Titolo Testata:
STROKE
fascicolo: 11, volume: 30, anno: 1999,
pagine: 2280 - 2284
SICI:
0039-2499(199911)30:11<2280:HTW3HO>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
TISSUE-PLASMINOGEN-ACTIVATOR; ACUTE ISCHEMIC STROKE; THERAPY; ARTERY; TRIAL;
Keywords:
prognosis; stroke, hemorrhagic; tissue plasminogen activator;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: Fiorelli, M Univ La Sapienza, Dept Neurol Sci, Viale Univ 30, I-00185 Rome, Italy Univ La Sapienza Viale Univ 30 Rome Italy I-00185 Rome, Italy
Citazione:
M. Fiorelli et al., "Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort", STROKE, 30(11), 1999, pp. 2280-2284

Abstract

Background and Purpose-The clinical correlates of the varying degrees of early hemorrhagic transformation of a cerebral infarct are unclear. We investigated the cohort of a randomized trial of thrombolysis to assess the early and late clinical course associated with different subtypes of hemorrhagic infarction (HI) and parenchymal hematoma (PII) detected within the first 36 hours of an ischemic stroke. Methods-We exploited the database of the European Cooperative Acute StrokeStudy I (ECASS I), a randomized, placebo-controlled, phase III trial of intravenous recombinant tissue plasminogen activator in acute ischemic stroke. Findings on 24- to 36- hour CT were classified into 5 categories: no hemorrhagic transformation, HI types 1 and 2, and PH types 1 and 2. We assessedthe risk of concomitant neurological deterioration and of 3-month death and disability associated with subtypes of hemorrhagic transformation, as opposed to no bleeding. Risks were adjusted for age and extent of ischemic damage on baseline CT. Results-Compared with absence of hemorrhagic transformation, HI1, HI2, andPH1 did not modify the risk of early neurological deterioration, death, and disability, whereas, in both the placebo and the recombinant tissue plasminogen activator groups, PH2 had a devastating impact on early neurologicalcourse (odds ratio for deterioration, 32.3; 95% CI, 13.4 to 77.7), and on 3-month death (odds ratio, 18.0; 95% CI, 8.05 to 40.1). Risk of disability was also higher, but not significantly, after PH2. Conclusions-Risk of early neurological deterioration and of 3-month death was severely increased after PH2, indicating that large hematoma is the only type of hemorrhagic transformation that may alter the clinical course of ischemic stroke.

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Documento generato il 28/11/20 alle ore 02:25:41