Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
J Neurol. 2021 Aug;268(8):2810-2820. doi: 10.1007/s00415-021-10449-1. Epub 2021 Feb 16.
Patients with intracranial hemorrhages (ICH) after mechanical thrombectomy (MT) may have a higher risk of early recurrent embolism (ERE) because of delayed initiation of anticoagulants. We assessed the rate of ischemic events in the early period after MT and the association with post-MT ICH.
Patients who underwent MT in our institute were retrospectively reviewed. ERE was defined as recurrent ischemic stroke and systemic embolism within 14 days after MT. The association between ERE and parenchymal hematoma (PH) was assessed. Multivariable regression analysis and inverse probability of treatment weighting was used to adjust for differences in baseline characteristics between patients with and without PH.
A total of 307 patients (median age, 78 years; female, 47%; median baseline National Institutes of Health Stroke Scale score, 19) were included. ERE was observed in 12 of 307 patients (8 strokes, 4 systemic embolisms; 3.9%). Median time from MT to ERE was 6.5 days (IQR, 3-8 days). PH occurred in 21 patients (6.8%). Median time from MT to initiating oral anticoagulants was longer in patients with PH (8 days) than in those without (3 days) (p < 0.01). In both unweighted and weighted multivariable analysis, PH was significantly associated with an increased risk of ERE (unweighted odds ratio, 10.60; 95% CI, 2.66-42.23; weighted odds ratio, 12.34; 95% CI, 2.49-61.07).
ERE occurred in about 4% of patients after MT. PH after MT was associated with delayed initiation of oral anticoagulants and an increased risk of recurrent ischemic events.
URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.
接受机械取栓（MT）后的颅内出血（ICH）患者由于抗凝药物启动延迟，可能有更高的早期复发性栓塞（ERE）风险。我们评估了 MT 后早期缺血性事件的发生率及其与 MT 后ICH 的关系。
回顾性分析在我院接受 MT 的患者。ERE 定义为 MT 后 14 天内发生的复发性缺血性卒中及全身栓塞。评估 ERE 与实质血肿（PH）之间的关系。多变量回归分析和逆概率治疗加权用于调整 PH 患者和非 PH 患者之间的基线特征差异。
共纳入 307 例患者（中位年龄 78 岁，女性 47%，中位基线国立卫生研究院卒中量表评分 19）。307 例患者中有 12 例（8 例卒中，4 例全身栓塞；3.9%）发生 ERE。MT 至 ERE 的中位时间为 6.5 天（IQR，3-8 天）。21 例患者发生 PH（6.8%）。PH 患者 MT 后开始口服抗凝药物的中位时间长于无 PH 患者（8 天比 3 天）（p<0.01）。在未加权和加权多变量分析中，PH 与 ERE 风险增加显著相关（未加权比值比，10.60；95%CI，2.66-42.23；加权比值比，12.34；95%CI，2.49-61.07）。
MT 后约 4%的患者发生 ERE。MT 后 PH 与口服抗凝药物启动延迟及复发性缺血性事件风险增加相关。
