2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Eur Radiol. 2019 Jun;29(6):3296-3307. doi: 10.1007/s00330-018-5869-1. Epub 2018 Dec 5.
To investigate the incidence and endovascular treatment of severe spontaneous non-cerebral hemorrhage (SSNCH) in a high-volume, tertiary university hospital.
All patients diagnosed with SSNCH between January 2016 and June 2017 were retrospectively analyzed. Endovascular treatment (group EVT) was offered only in patients demonstrating active bleeding at CT angiography (CTA). In cases without active bleeding at CTA, conservative management was decided (group CM). Outcome measures included the incidence of SSNCH, 6-month rebleeding, and survival rates in the two groups as well as EVT technical success and related complications.
Within the 18-month period, 44 SSNCH cases were identified, resulting in an annual incidence of 29.3 cases. In 37/44 cases (84.1%), bleeding was attributed to the antithrombotic therapy. In total, 19/44 patients underwent EVT (43.2%), and 25/44 patients (56.8%) were managed conservatively. Two patients who were initially treated conservatively finally underwent EVT due to rebleeding (7.4%). The technical success of EVT was 100%, while rebleeding occurred in 1 case (5.2%) following lumbar artery embolization and was successfully re-embolized. According to the Kaplan-Meier analysis, the 1-, 3-, and 6-month survival rates were 68.4%, 63.2%, and 42.1% for group EVT and 87.5%, 75.0%, and 58.3% for group CM, respectively. There were no EVT-related complications.
The annual incidence of SSNCH in our institution is substantial. EVT resulted in uncomplicated, high bleeding control rates. The mortality rate was similarly high following either EVT or conservative treatment and was mainly attributed to severe comorbidities.
• This study demonstrates that the incidence of severe spontaneous non-cerebral hemorrhage (SSNCH) in our institution is substantial. • Endovascular treatment was offered only in patients with clinical signs of ongoing hemorrhage and active bleeding at CT angiography and resulted in effective and uncomplicated, minimal invasive hemostasis, in a population with severe comorbidities. • This is the first study to evaluate the outcomes of both endovascular hemostasis and conservative management. Rebleeding following either conservative or endovascular treatment was minimal.
研究在一家大型三级大学医院中严重自发性非脑出血（SSNCH）的发生率和血管内治疗情况。
回顾性分析 2016 年 1 月至 2017 年 6 月期间诊断为 SSNCH 的所有患者。仅在 CT 血管造影（CTA）显示有活动性出血的患者中进行血管内治疗（EVT 组）。在 CTA 无活动性出血的情况下，决定采用保守治疗（CM 组）。观察指标包括两组的 SSNCH 发生率、6 个月再出血率和生存率，以及 EVT 技术成功率和相关并发症。
在 18 个月期间，共发现 44 例 SSNCH 病例，年发病率为 29.3 例。在 37/44 例（84.1%）中，出血归因于抗血栓治疗。共有 19/44 例患者接受了 EVT（43.2%），25/44 例患者（56.8%）采用保守治疗。最初采用保守治疗的 2 例患者因再出血（7.4%）最终接受了 EVT。EVT 的技术成功率为 100%，但在腰椎动脉栓塞后出现 1 例（5.2%）再出血，经再次栓塞成功治疗。根据 Kaplan-Meier 分析，EVT 组 1、3、6 个月生存率分别为 68.4%、63.2%和 42.1%，CM 组分别为 87.5%、75.0%和 58.3%。EVT 无相关并发症。
本机构 SSNCH 的年发病率很高。EVT 可实现较高的出血控制率，且操作简单。无论采用 EVT 还是保守治疗，死亡率均较高，主要与严重的合并症有关。
本研究表明，本机构严重自发性非脑出血（SSNCH）的发病率很高。
仅对有临床出血迹象和 CTA 显示有活动性出血的患者行血管内治疗，EVT 治疗结果有效且操作简单，对合并严重疾病的患者进行微创止血效果良好。
这是第一项评估血管内止血和保守治疗结果的研究。保守治疗或血管内治疗后再出血均很少见。
