神经血栓切除术治疗后颅内出血发生及预后的决定因素：来自Solitaire FR颅内取栓随机试验的见解
Determinants of Intracranial Hemorrhage Occurrence and Outcome after Neurothrombectomy Therapy: Insights from the Solitaire FR With Intention For Thrombectomy Randomized Trial.
作者信息
Raychev R, Jahan R, Liebeskind D, Clark W, Nogueira R G, Saver J
机构信息
From the Department of Neurology (R.R., D.L., J.S.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California
Division of Interventional Neuroradiology (R.J.) Stroke Center (R.R., R.J., D.L., J.S.), University of California, Los Angeles, Los Angeles, California.
出版信息
AJNR Am J Neuroradiol. 2015 Dec;36(12):2303-7. doi: 10.3174/ajnr.A4482. Epub 2015 Aug 27.
BACKGROUND AND PURPOSE
Intracranial hemorrhage is the most dreaded complication of neurothrombectomy therapy for acute ischemic stroke. The determinants of intracranial hemorrhage and its impact on clinical course remain incompletely delineated. The purpose of this study is to further investigate the clinical and procedural factors leading to intracranial hemorrhage and to define the clinical impact of different hemorrhagic subtypes.
MATERIALS AND METHODS
We analyzed data prospectively collected in the Solitaire FR With Intention for Thrombectomy randomized clinical trial. A multivariable logistic regression model was used to identify independent clinical, imaging, and procedural predictors of any intracranial hemorrhage and of 7 intracranial hemorrhage subtypes. Univariate analysis was used to determine the impact of each of the intracranial hemorrhage subtypes on clinical outcome.
RESULTS
Among the 144 enrolled patients, any radiologic intracranial hemorrhage (21.3% versus 38.2%, P = .035), symptomatic intracranial hemorrhage (1.1% versus 10.9%, P = .012), and subarachnoid hemorrhage (2.2% versus 12.7%, P = .027) occurred less frequently in the Solitaire FR than in the Merci retriever arms. The most common independent determinant of hemorrhage occurrence was rescue therapy with intra-arterial rtPA, which was associated with any intracranial hemorrhage and 4 subtypes and tended to be used more frequently in the Merci group (10.9% versus 3.4%; P = .09). Among the hemorrhage subtypes, basal ganglionic hemorrhage had the strongest impact on good clinical outcome at 90 days (OR, 0.30; P = .025) and was associated with higher reperfusion, prolonged time to treatment, and rescue therapy with intra-arterial rtPA.
CONCLUSIONS
Intracranial hemorrhage, especially subarachnoid and symptomatic intracerebral hemorrhage, occurs less frequently with the Solitaire FR than the Merci retriever, in part due to less frequent use of rescue therapy with intra-arterial rtPA. Basal ganglionic hemorrhage strongly affects clinical outcome and is distinctively related to late reperfusion.
背景与目的
颅内出血是急性缺血性卒中神经血栓切除术治疗最可怕的并发症。颅内出血的决定因素及其对临床病程的影响仍未完全阐明。本研究的目的是进一步调查导致颅内出血的临床和操作因素，并确定不同出血亚型的临床影响。
材料与方法
我们分析了在Solitaire FR血栓切除术随机临床试验中前瞻性收集的数据。使用多变量逻辑回归模型来确定任何颅内出血和7种颅内出血亚型的独立临床、影像学和操作预测因素。单变量分析用于确定每种颅内出血亚型对临床结局的影响。
结果
在144例入组患者中，Solitaire FR组的任何放射性颅内出血（21.3%对38.2%，P = 0.035）、症状性颅内出血（1.1%对10.9%，P = 0.012）和蛛网膜下腔出血（2.2%对12.7%，P = 0.027）的发生率均低于Merci取栓器组。出血发生的最常见独立决定因素是动脉内rtPA抢救治疗，其与任何颅内出血和4种亚型相关，且在Merci组中使用频率更高（10.9%对3.4%；P = 0.09）。在出血亚型中，基底节出血对90天时良好临床结局的影响最强（OR，0.30；P = 0.025），并与更高的再灌注、更长的治疗时间和动脉内rtPA抢救治疗相关。
结论
使用Solitaire FR时颅内出血，尤其是蛛网膜下腔和症状性脑出血的发生率低于Merci取栓器，部分原因是动脉内rtPA抢救治疗的使用频率较低。基底节出血强烈影响临床结局，且与晚期再灌注明显相关。
Zotero 插件