Department of Neurology, University Hospital RWTH, Aachen, Germany,
Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH, Aachen, Germany.
Cerebrovasc Dis. 2021;50(2):162-170. doi: 10.1159/000512204. Epub 2021 Jan 20.
While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates.
We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (n = 73) versus without acute CAS (n = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded.
Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, p < 0.001 and sICH: 16.4 vs. 2.9%, p < 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (p = 0.213).
AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.
血管内治疗（EST）急性缺血性脑卒中（AIS）的大血管闭塞是安全有效的，但某些患者会发生出血并发症。本研究旨在确定颅内出血的危险因素，并评估急性颈动脉支架置入术（CAS）是否与出血率增加相关。
回顾性分析 2010 年 5 月至 2018 年 5 月于我院行前瞻性卒中登记的患者，比较接受 EST 治疗的 AIS 患者（n=73）与未接受急性 CAS 治疗的患者（n=548）。排除颅内支架置入、动脉内溶栓或颈动脉夹层患者。
接受 EST 治疗并同时行急性 CAS 的患者中，实质内出血（PH2 根据 ECASS 分类）和症状性出血（sICH）的发生率更高，比值比分别为 6.3（PH2）和 6.5（sICH）（PH2：17.8% vs. 3.3%，p<0.001；sICH：16.4% vs. 2.9%，p<0.001）。同时接受静脉内重组组织型纤溶酶原激活剂（IVRTPA）治疗不是脑出血的危险因素（p=0.213）。
接受 EST 治疗并同时行急性 CAS 及随后的替罗非班或双联抗血小板治疗的 AIS 患者，发生相关继发性颅内出血的风险增加。在调整混杂因素后，替罗非班和双联抗血小板治疗与更高的出血率相关。
