Xu Feng, Lian Lifei, Liang Qiming, Pan Chao, Pan Chu, Hu Qi, Chen Rudong, Wang Furong, Zhang Min, Tang Zhouping, Zhu Suiqiang
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Clin Neurol Neurosurg. 2019 May;180:62-67. doi: 10.1016/j.clineuro.2019.03.013. Epub 2019 Mar 15.
Limited evidence supports the presumed increased frequency of hemorrhage caused by the unruptured intracranial aneurysms which coexist in patients with spontaneous intracerebral hemorrhage treated with minimally invasive surgery plus local thrombolysis. Subsequently, we sought to determine the safety of local thrombolysis for this particular subset of patients.
We reviewed the medical records of patients treated with minimally invasive surgery plus local thrombolysis for intracerebral hemorrhage between November 2013 to December 2015 in an intensive care unit of a tertiary care hospital. Depending upon the vascular images, unruptured intracranial aneurysms were identified. The primary outcome was any of postoperative intracranial rebleeding. The second outcome included the 30-day death and 6-month follow up graded by Modified Rank Scale. Blind abstractors reviewed the medical data and binary logistic regression was performed to investigate the risk factors of poor prognosis.
We identified a cohort of consecutive 188 patients, of whom 23 (12.2%) harbored unruptured intracranial aneurysms. There were 28 aneurysms documented in this study, among which 3 were in the posterior circulation. And in total, 20 (11.3%) cases suffered from postoperative hematoma growth, of which 4 were with aneurysms. Additionally,the 30-day mortality after stroke in patients with aneurysms was 8.69% (2/23), comparable to 13.33% in without (22/165,p = 0.744). The proportion of the favorable outcome at 6-month follow-up in patients with aneurysms was comparable to that in without (47.8% versus 48.5%,p = 1.000) Insignificant associations were demonstrated between the unruptured intracranial aneurysms and postoperative intracranial rehemorrhage (p = 0.092), 30-day death(p = 0.588) and poor long-term prognosis (p = 0.332), respectively.
Our findings suggest that unruptured intracranial aneurysms seem to represent no increased risks of poor outcome after local thrombolysis for intracerbral hematomas.
有限的证据支持一种推测，即微创外科手术联合局部溶栓治疗的自发性脑出血患者中并存的未破裂颅内动脉瘤会增加出血频率。随后，我们试图确定局部溶栓治疗这类特定患者亚组的安全性。
我们回顾了2013年11月至2015年12月在一家三级护理医院重症监护病房接受微创外科手术联合局部溶栓治疗脑出血患者的病历。根据血管影像识别未破裂颅内动脉瘤。主要结局是术后颅内再出血。次要结局包括30天死亡率和改良Rankin量表评估的6个月随访结果。盲法摘要提取人员审查医疗数据，并进行二元逻辑回归分析以研究预后不良的危险因素。
我们确定了连续的188例患者队列，其中23例（12.2%）患有未破裂颅内动脉瘤。本研究共记录了28个动脉瘤，其中3个位于后循环。总共有20例（11.3%）患者术后血肿增大，其中4例伴有动脉瘤。此外，有动脉瘤患者的卒中后30天死亡率为8.69%（2/23），与无动脉瘤患者的13.33%（22/165）相当（p = 0.744）。有动脉瘤患者6个月随访时良好结局的比例与无动脉瘤患者相当（47.8%对48.5%，p = 1.000）。未破裂颅内动脉瘤与术后颅内再出血（p = 0.092）、30天死亡率（p = 0.588）和长期预后不良（p = 0.332）之间均无显著关联。
我们的研究结果表明，未破裂颅内动脉瘤在脑内血肿局部溶栓治疗后似乎不会增加不良结局的风险。
