Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Neurointerv Surg. 2021 Dec;13(12):1095-1098. doi: 10.1136/neurintsurg-2020-017123. Epub 2021 Feb 8.
Intracerebral hemorrhage (ICH) occurs in ~20%-30% of stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. We sought to evaluate the effect of aICH on immediate and 90-day post-EVT neurological outcomes.
In this post-hoc analysis of the multicenter, prospective Blood Pressure after Endovascular Therapy (BEST) study we identified subjects with ICH following EVT. This population was divided into no ICH, aICH, and symptomatic ICH (sICH). Associations with 90-day modified Rankin Scale (mRS) dichotomized by functional independence (0-2 vs 3-6) and early neurological recovery (ENR) were determined using univariate/multivariate logistic regression models.
Of 485 patients enrolled in BEST, 446 had 90-day follow-up data available. 92 (20.6%) developed aICH, and 18 (4%) developed sICH. Compared with those without ICH, aICH was not associated with worse 90-day outcome or lower ENR (OR 0.84 [0.53-1.35], P=0.55, aOR 0.84 [0.48-1.44], P=0.53 for 90-day mRS 0-2; OR 0.77 [0.48-1.23], P=0.34, aOR 0.72 [0.43-1.22] for ENR). aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2 b (OR 0.78 [0.48-1.26], P=0.33 for 90-day mRS 0-2; OR 0.89 [0.69-1.12], P=0.15 for ENR). A higher proportion of patients with aICH had mTICI ≥2 b than those without ICH (97%vs 87%, P=0.01).
aICH was not associated with worse outcomes in patients with large-vessel stroke treated with EVT. aICH was more frequent in patients with successful recanalization. Further validation of our findings in large cohort studies of EVT-treated patients is warranted.
接受血管内治疗 (EVT) 的中风患者约有 20%-30%发生脑出血 (ICH)。然而，无症状性 ICH (aICH) 对 EVT 后结局的影响存在相互矛盾的证据。我们旨在评估 aICH 对 EVT 后即刻和 90 天神经功能结局的影响。
在这项多中心、前瞻性的血管内治疗后血压 (BEST) 研究的事后分析中，我们确定了 EVT 后发生 ICH 的患者。该人群分为无 ICH、aICH 和症状性 ICH (sICH)。使用单变量/多变量逻辑回归模型确定与 90 天改良 Rankin 量表 (mRS) 二分法(功能独立性为 0-2 与 3-6)和早期神经恢复 (ENR) 的相关性。
在 BEST 研究中，485 名患者中有 446 名患者有 90 天随访数据。92 名(20.6%)患者发生 aICH，18 名(4%)患者发生 sICH。与无 ICH 患者相比，aICH 与 90 天结局较差或 ENR 较低无关 (OR 0.84 [0.53-1.35]，P=0.55，aOR 0.84 [0.48-1.44]，P=0.53 用于 90 天 mRS 0-2；OR 0.77 [0.48-1.23]，P=0.34，aOR 0.72 [0.43-1.22] 用于 ENR)。在 mTICI≥2b 的患者中，aICH 与 90 天结局或 ENR 无关 (OR 0.78 [0.48-1.26]，P=0.33 用于 90 天 mRS 0-2；OR 0.89 [0.69-1.12]，P=0.15 用于 ENR)。与无 ICH 患者相比，aICH 患者 mTICI≥2b 的比例更高 (97%对 87%，P=0.01)。
在接受 EVT 治疗的大血管卒中患者中，aICH 与结局不佳无关。在再通成功的患者中，aICH 更为常见。需要在接受 EVT 治疗的患者的大型队列研究中进一步验证我们的发现。
