Tian Bing, Tian Xia, Shi Zhang, Peng Wenjia, Zhang Xuefeng, Yang Pengfei, Li Zifu, Zhang Xiaoxi, Lou Min, Yin Congguo, Zhang Yongwei, Lu Jianping, Liu Jianmin
Department of Radiology (B.T., X.T., Z.S., W.P., Xuefeng Zhang, J. Lu), Changhai hospital of Shanghai, China.
Neurovascular Center (P.Y., Z.L., Xiaoxi Zhang, J. Liu), Changhai hospital of Shanghai, China.
Stroke. 2022 May;53(5):1674-1681. doi: 10.1161/STROKEAHA.121.035425. Epub 2021 Dec 7.
Prior studies have investigated the clinical and imaging factors for hemorrhagic transformation (HT), especially symptomatic intracranial hemorrhage (sICH); however, whether alteplase increases the risk of HT after endovascular thrombectomy (EVT) is unknown. This study aimed to assess clinical and imaging features associated with HT, sICH, and parenchymal hematoma (PH) in patients with acute ischemic stroke after EVT, with and without intravenous alteplase in DIRECT-MT (Direct Intraarterial Thrombectomy to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial).
The DIRECT-MT trial is a randomized trial of EVT alone versus intravenous thrombolysis combined with EVT. HT, sICH, and PH was evaluated on follow-up computed tomography. Multivariable ordinal logistic regression analysis was used to test the association of stepwise selected determinants with HT, sICH, and PH.
In total, 633 patients were analyzed; 261 (41.2%) had HT; 34 (5.4%) had sICH; and 85 (13.4%) had PH. The median age was 69, and 56.7% were men. The median National Institutes of Health Stroke Scale score was 18, and 320 patients were in combination-therapy group. Symptomatic intracranial hemorrhage was associated with higher baseline National Institutes of Health Stroke Scale score (adjusted odds ratio [OR], 1.06 [95% CI, 1.10-1.12]) and higher glucose level at hospital arrival (adjusted OR, 1.14 [95% CI, 1.00-1.29]). No association was found between alteplase treatment and HT, sICH, or PH. The independent predictor of sICH was higher baseline National Institutes of Health Stroke Scale score (adjusted OR, 1.09 [95% CI, 1.01-1.18]) in EVT alone group, and history of anticoagulant drugs (adjusted OR, 3.75 [95% CI, 1.07-13.06]), higher glucose level at hospital arrival (adjusted OR, 1.19 [95% CI, 1.03-1.38]), >3 passes of device (adjusted OR, 4.42 [95% CI, 1.36-14.32]) in combination-therapy group.
In DIRECT-MT, independent predictors of sICH were baseline National Institutes of Health Stroke Scale score and glucose level at hospital arrival. Alteplase treatment did not increase the risk of HT, sICH, or PH after EVT. The independent predictor of sICH was different in EVT alone group and combination-therapy group.
URL: https://www.
gov; Unique identifier: NCT03469206.
既往研究已对出血性转化（HT），尤其是症状性颅内出血（sICH）的临床和影像学因素进行了调查；然而，阿替普酶是否会增加血管内血栓切除术（EVT）后HT的风险尚不清楚。本研究旨在评估DIRECT-MT（在中国三级医院有效对急性缺血性卒中伴大血管闭塞患者进行直接动脉内血栓切除术：一项多中心随机临床试验）中接受或未接受静脉注射阿替普酶的急性缺血性卒中患者EVT后与HT、sICH和脑实质血肿（PH）相关的临床和影像学特征。
DIRECT-MT试验是一项比较单纯EVT与静脉溶栓联合EVT的随机试验。在随访计算机断层扫描中评估HT、sICH和PH。采用多变量有序逻辑回归分析来检验逐步选择的决定因素与HT、sICH和PH之间的关联。
总共分析了633例患者；261例（41.2%）发生HT；34例（5.4%）发生sICH；85例（13.4%）发生PH。中位年龄为69岁，男性占56.7%。美国国立卫生研究院卒中量表评分中位数为18分，320例患者在联合治疗组。症状性颅内出血与较高的基线美国国立卫生研究院卒中量表评分（调整优势比[OR]，1.06[95%CI，1.10 - 1.12]）和入院时较高的血糖水平（调整OR，1.14[95%CI，1.00 - 1.29]）相关。未发现阿替普酶治疗与HT、sICH或PH之间存在关联。sICH的独立预测因素在单纯EVT组中是较高的基线美国国立卫生研究院卒中量表评分（调整OR，1.09[95%CI，1.01 - 1.18]），在联合治疗组中是抗凝药物使用史（调整OR，3.75[95%CI，1.07 - 13.06]）、入院时较高的血糖水平（调整OR，1.19[95%CI，1.03 - 1.38]）、器械操作>3次（调整OR，4.42[95%CI，1.36 - 14.32]）。
在DIRECT-MT中，sICH的独立预测因素是基线美国国立卫生研究院卒中量表评分和入院时的血糖水平。阿替普酶治疗并未增加EVT后HT、sICH或PH的风险。sICH的独立预测因素在单纯EVT组和联合治疗组中有所不同。
网址：https://www.
gov；唯一标识符：NCT03469206。
