Qureshi Adnan I, Saleem Muhammad A, Aytac Emrah
Zeenat Qureshi Stroke Institute, St. Cloud, MN.
J Neuroimaging. 2017 Sep;27(5):493-498. doi: 10.1111/jon.12430. Epub 2017 Mar 9.
The rate of occurrence and associated outcomes of subarachnoid hemorrhage (SAH) in acute ischemic stroke patients following endovascular treatment is not well studied.
We analyzed data from subjects treated with intravenous recombinant tissue plasminogen activator followed by endovascular treatment in the Interventional Management of Stroke III trial. The baseline and 24 (±6) hours postrandomization computed tomographic scans were interpreted centrally for presence, type, and location of intracranial hemorrhages (ICHs) including SAH. The primary outcome assessment was by modified Rankin scale (mRS) score at 3 months.
Of these 323 subjects who underwent endovascular treatment, the patterns of postprocedure ICHs were as follows: none (n = 168), isolated SAH (type 1, n = 9), SAH with intraparenchymal hemorrhage (IPH) or other ICHs (type 2, n = 33), and IPH or other ICHs without SAH (n = 113). At 3 months, the rates of independent functional outcome (mRS 0-2) were lower among subjects with type 2 SAHs (odds ratio [OR] .2; 95% confidence interval [CI] .1-.8; P = .016), and IPH or other ICHs without SAH (OR .5; 95% CI .3-.9; P = .022) but not in subjects with type 1 SAH (OR .8; 95% CI .2-3.5; P = .810), after adjusting for age, baseline serum glucose levels, National Institutes of Health Stroke Scale score strata, and procedure related complications.
The rates of independent functional outcome were lower among subjects with postprocedure type 2 SAHs but not in subjects with type 1 SAH.
血管内治疗后急性缺血性卒中患者蛛网膜下腔出血（SAH）的发生率及相关结局尚未得到充分研究。
我们分析了卒中介入管理III期试验中接受静脉注射重组组织型纤溶酶原激活剂后再进行血管内治疗的受试者的数据。对随机分组后24（±6）小时的基线计算机断层扫描进行集中解读，以确定颅内出血（ICH）包括SAH的存在、类型和位置。主要结局评估采用3个月时的改良Rankin量表（mRS）评分。
在这323例接受血管内治疗的受试者中，术后ICH的模式如下：无（n = 168）、孤立性SAH（1型，n = 9）、伴有脑实质内出血（IPH）或其他ICH的SAH（2型，n = 33）、无SAH的IPH或其他ICH（n = 113）。在3个月时，在调整年龄、基线血清葡萄糖水平、美国国立卫生研究院卒中量表评分分层和与手术相关的并发症后，2型SAH受试者（优势比[OR].2；95%置信区间[CI].1-.8；P = .016）以及无SAH的IPH或其他ICH受试者（OR.5；95% CI.3-.9；P = .022）的独立功能结局（mRS 0-2）发生率较低，但1型SAH受试者（OR.8；95% CI.2-3.5；P = .810）并非如此。
术后2型SAH受试者的独立功能结局发生率较低，但1型SAH受试者并非如此。
