van Kranendonk Katinka R, Treurniet Kilian M, Boers Anna M M, Berkhemer Olvert A, van den Berg Lucie A, Chalos Vicky, Lingsma Hester F, van Zwam Wim H, van der Lugt Aad, van Oostenbrugge Robert J, Dippel Diederik W J, Roos Yvo B W E M, Marquering Henk A, Majoie Charles B L M
From the Department of Radiology and Nuclear Medicine (K.R.v.K., K.M.T., A.M.M.B., O.A.B., C.B.L.M.M.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands.
Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands.
Stroke. 2019 Aug;50(8):2037-2043. doi: 10.1161/STROKEAHA.118.024255. Epub 2019 Jul 1.
Background and Purpose- Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods- In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of <0.1 were included in the multivariable logistic regression to identify clinical and radiological variables associated with petechial hemorrhagic infarction, parenchymal hematoma (PH), and symptomatic intracranial hemorrhage. Results- Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01-1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05-3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05-1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08-3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12-1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08-6.3) were associated with symptomatic intracranial hemorrhage. Conclusions- Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration- URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758.
背景与目的——急性缺血性卒中后的出血性转化(HT)可能导致严重的神经功能恶化,并影响功能结局。识别最有可能发生这种并发症的患者可能有助于未来的治疗选择。血管内治疗后的再灌注与HT的危险因素可能与静脉溶栓不同,因为这两种治疗方法有很大差异。在本研究中,我们旨在确定与荷兰急性缺血性卒中血管内治疗多中心随机临床试验(MR CLEAN)人群中HT亚型相关的临床和影像标志物。方法——在这项事后分析中,纳入了所有有随访影像的患者。HT根据欧洲急性卒中协作研究(ECASS II)进行分类。将关联度<0.1的变量纳入多变量逻辑回归,以识别与点状出血性梗死、脑实质血肿(PH)和症状性颅内出血相关的临床和放射学变量。结果——在该亚分析纳入的500例患者中,有478例(46%,n = 222)发生了HT。其中,66%(n = 147)为出血性梗死,34%(n = 75)为PH。所有患者中7.3%(n = 35)观察到症状性颅内出血。基线美国国立卫生研究院卒中量表(比值比[OR],1.05,95%置信区间[CI],每增加1分1.01 - 1.09)和侧支循环缺失/不良(OR,1.90;95% CI,1.05 - 3.42)与出血性梗死显著相关。收缩压升高(OR,1.17;95% CI,每升高10 mmHg 1.05 - 1.31)和心房颤动(OR,1.94;95% CI,1.08 - 3.48)与PH相关。收缩压升高(OR,1.28;95% CI,1.12 - 1.48)和使用抗血小板药物(OR,2.6;95% CI,1.08 - 6.3)与症状性颅内出血相关。结论——临床和影像卒中严重程度参数与HT相关,在出血性梗死和PH中均如此,而收缩压、心房颤动和抗血小板药物使用等基线患者特征仅与PH或症状性颅内出血相关。临床试验注册——网址:http://www.controlled-trials.com。唯一标识符:ISRCTN10888758。