INTRODUCTION Symptomatic intracranial hemorrhage represents one of the most feared complications of endovascular reperfusion. We aim to describe a series of patients that experienced immediate reperfusion injury with active intraprocedural extravasation within the territory of the deep penetrating arteries and provide real-time correlation with CT "spot sign." METHODS This was a retrospective analysis of patients that suffered reperfusion injury with active arterial extravasation during endovascular stroke treatment in two tertiary care centers. RESULTS Five patients were identified. Median age was 63 (58-71) years, 66% were male. Median NIHSS was 13.5 (9.5-23.0), platelet level 212,000 (142,000-235,000), baseline systolic blood pressure 152 (133-201) mm Hg, and non-contrast CT ASPECTS 7.0 (6.5-9.0). Two patients were taking aspirin and one had received intravenous thrombolysis. There were three middle cerebral artery M1, one internal carotid artery terminus, and one vertebrobasilar junction occlusion. Three patients had anterior circulation tandem occlusions. Stroke etiology was extracranial atherosclerosis (n = 2), intracranial atherosclerosis (n = 2), and cervical dissection (n = 1). The median time from onset to puncture was 5.5 (3.9-8.6) h. Intravenous heparin was administered in all patients (median dose of 4,750 [3,250-6,000] units) and intravenous abciximab in four. All tandem cases had the cervical lesion addressed first. Four lenticulostriates and one paramedian pontine artery were involved. Intraprocedural flat-panel CT was performed in four (80%) cases and provided real-time correlation between the active contrast extravasation and the "spot sign." The bailout included use of protamine, blood pressure control, and balloon guide catheter or intracranial compliant balloon inflation plus coiling of targeted vessel. All patients had angiographic cessation of bleeding at the end of the procedure with parenchymal hemorrhage type 1 in one case and type 2 in four. Three patients had modified Rankin score of 4 and two were dead at 90 days. CONCLUSIONS Active reperfusion hemorrhage involving perforator arteries was observed to correlate with the CT "spot sign" and to be associated with poor outcomes.

中文翻译：

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血栓切除术中的活动性再灌注出血：血管造影结果和与 CT“点征”的实时相关性。

引言 有症状的颅内出血是血管内再灌注最可怕的并发症之一。我们的目标是描述一系列在深部穿通动脉区域内经历直接再灌注损伤并伴有活动性术中外渗的患者，并提供与 CT“点征”的实时相关性。方法 这是对两个三级医疗中心在血管内卒中治疗期间发生再灌注损伤并伴有活动性动脉外渗的患者的回顾性分析。结果 确定了 5 名患者。中位年龄为 63 (58-71) 岁，66% 为男性。中位 NIHSS 为 13.5 (9.5-23.0)，血小板水平 212,000 (142,000-235,000)，基线收缩压 152 (133-201) mm Hg，非增强 CT ASPECTS 7.0 (6.5-9.0)。两名患者服用阿司匹林，一名接受静脉溶栓治疗。大脑中动脉M1 3条，颈内动脉末端1条，椎基底动脉交界处1条。三名患者有前循环串联阻塞。中风病因是颅外动脉粥样硬化（n = 2）、颅内动脉粥样硬化（n = 2）和颈椎夹层（n = 1）。从发病到穿刺的中位时间为 5.5 (3.9-8.6) h。所有患者均静脉注射肝素（中位剂量为 4,750 [3,250-6,000] 单位），4 例患者静脉注射阿昔单抗。所有串联病例均首先处理宫颈病变。涉及4个豆纹肌和1个脑桥旁正中动脉。在四例 (80%) 病例中进行了术中平板 CT，并提供了主动造影剂外渗和“点征”之间的实时相关性。救助包括使用鱼精蛋白、血压控制和球囊引导导管或颅内顺应性球囊膨胀以及目标血管的盘绕。所有患者在手术结束时进行血管造影止血，1 型实质出血 1 例，2 型 4 例。3 名患者的改良 Rankin 评分为 4，2 名患者在 90 天时死亡。结论 观察到涉及穿支动脉的活动性再灌注出血与 CT“点征”相关，并与不良预后相关。和球囊引导导管或颅内顺应性球囊充气以及目标血管的盘绕。所有患者在手术结束时进行血管造影止血，1 型实质出血 1 例，2 型 4 例。3 名患者的改良 Rankin 评分为 4，2 名患者在 90 天时死亡。结论 观察到涉及穿支动脉的活动性再灌注出血与 CT“点征”相关，并与不良预后相关。和球囊引导导管或颅内顺应性球囊充气以及目标血管的盘绕。所有患者在手术结束时进行血管造影止血，1 型实质出血 1 例，2 型 4 例。3 名患者的改良 Rankin 评分为 4，2 名患者在 90 天时死亡。结论 观察到涉及穿支动脉的活动性再灌注出血与 CT“点征”相关，并与不良预后相关。