Nogueira Raul G, Gupta Rishi, Jovin Tudor G, Levy Elad I, Liebeskind David S, Zaidat Osama O, Rai Ansaar, Hirsch Joshua A, Hsu Daniel P, Rymer Marilyn M, Tayal Ashis H, Lin Ridwan, Natarajan Sabareesh K, Nanda Ashish, Tian Melissa, Hao Qing, Kalia Junaid S, Chen Michael, Abou-Chebl Alex, Nguyen Thanh N, Yoo Albert J
Emory University School of Medicine, Atlanta, Georgia, USA.
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg. 2015 Jan;7(1):16-21. doi: 10.1136/neurintsurg-2013-010743. Epub 2014 Jan 8.
Endovascular techniques are frequently employed to treat large artery occlusion in acute ischemic stroke (AIS). We sought to determine the predictors and clinical impact of intracranial hemorrhage (ICH) after endovascular therapy.
Retrospective analysis of consecutive patients presenting to 13 high volume stroke centers with AIS due to proximal occlusion in the anterior circulation who underwent endovascular treatment within 8 h from symptom onset. Logistic regression was performed to determine the variables associated with ICH, hemorrhagic infarction (HI), and parenchymal hematomas (PHs), as well as 90 day poor outcome (modified Rankin Scale score ≥3) and mortality.
There were a total of 363 ICHs (overall rate 32.3%; HI=267, 24%; PH=96, 8.5%) among the 1122 study patients (mean age 67±15 years; median National Institutes of Health Stroke Scale score 17 (IQR 13-20)). Independent predictors for HI included diabetes mellitus (OR 2.27, 95% CI (1.58 to 3.26), p<0.0001), preprocedure IV tissue plasminogen activator (tPA) (1.43 (1.03 to 2.08), p<0.037), Merci thrombectomy (1.47 (1.02 to 2.12), p<0.032), and longer time to puncture (1.001 (1.00 to 1.002), p<0.026). Patients with atrial fibrillation (1.61 (1.01 to 2.55), p<0.045) had a higher risk of PH while the use of IA tPA (0.57 (0.35 to 0.90), p<0.008) was associated with lower chances of PH. Both the presence of HI (2.23 (1.53 to 3.25), p<0.0001) and PH (6.24 (3.06 to 12.75), p<0.0001) were associated with poor functional outcomes; however, only PH was associated with higher mortality (3.53 (2.19 to 5.68), p<0.0001).
Greater understanding about the predictors and consequences of ICH post endovascular stroke therapy is essential to improve risk assessment, patient selection/clinical outcomes, and early prognostication. Our data suggest that patients with atrial fibrillation are particularly prone to severe ICH and question the 'benign' nature of HI suggested by earlier studies.
血管内技术常用于治疗急性缺血性卒中（AIS）的大动脉闭塞。我们试图确定血管内治疗后颅内出血（ICH）的预测因素及临床影响。
对13个高容量卒中中心连续收治的因前循环近端闭塞导致AIS且在症状发作8小时内接受血管内治疗的患者进行回顾性分析。采用逻辑回归确定与ICH、出血性梗死（HI）、脑实质血肿（PH）以及90天不良预后（改良Rankin量表评分≥3）和死亡率相关的变量。
1122例研究患者（平均年龄67±15岁；美国国立卫生研究院卒中量表评分中位数为17（四分位间距13 - 20））中共有363例发生ICH（总发生率32.3%；HI = 267例，24%；PH = 96例，8.5%）。HI的独立预测因素包括糖尿病（比值比2.27，95%置信区间（1.58至3.26），p < 0.0001）、术前静脉注射组织型纤溶酶原激活剂（tPA）（1.43（1.03至2.08），p < 0.037）、Merci取栓术（1.47（1.02至2.12），p < 0.032）以及穿刺时间延长（1.001（1.00至1.002），p < 0.026）。心房颤动患者发生PH的风险较高（1.61（1.01至2.55），p < 0.045），而动脉内使用tPA（0.57（0.35至0.90），p < 于0.008）与PH发生几率较低相关。HI（2.23（1.53至3.25），p < 0.0001）和PH（6.24（3.06至12.75），p < 0.0001）均与功能预后不良相关；然而，只有PH与较高死亡率相关（3.53（2.19至5.68），p < 0.0001）。
深入了解血管内卒中治疗后ICH的预测因素及后果对于改善风险评估、患者选择/临床结局以及早期预后判断至关重要。我们的数据表明，心房颤动患者尤其容易发生严重ICH，并对早期研究提出的HI的“良性”性质提出质疑。
