Lopez-Navarro Edgar R, Delfs Christofer, Jarre Andrea, Sanio Vivian, Greif Götz, Gutierrez Jose, Ringelstein E Bernd, Meuth Sven G, Haensch Carl-Albrecht, Ringelstein Adrian, Ringelstein Marius
Department of Neurology, Johanna Etienne Krankenhaus, Neuss, Germany.
Department of Radiology and Neuroradiology, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, NRW, Germany.
Clin Neuroradiol. 2022 Dec;32(4):961-969. doi: 10.1007/s00062-022-01152-3. Epub 2022 Mar 16.
Despite improved techniques and sophisticated postinterventional care, symptomatic intracranial hemorrhage (sICH) remains the most feared complication of mechanical thrombectomy (MT). Based on peri-interventional parameters, we aimed to discover which patients have a higher risk of sICH.
From March 2017 until March 2020 consecutive patients with acute ischemic stroke (AIS) and confirmed large-vessel occlusion who underwent MT were analyzed retrospectively. Demographic, clinical, and radiological variables and parameters specific to thrombectomy were reviewed. A univariate analysis was performed and statistically significant variables were included in a logistic regression model to identify independent factors predictive of sICH.
A total of 236 patients with confirmed large-vessel occlusion were included and 22 (9.3%) had sICH. Univariate predictors of sICH included diabetes mellitus, glucose > 11.1 mmol/L, creatinine clearance (CrCl) ≤ 30 ml/min/1.73, ASPECTS indicating pretreatment infarct size, acute internal carotid artery (ICA) occlusion, stent implantation, tirofiban use, time from symptom onset to groin puncture > 4.5 h and high contrast medium consumption. In the adjusted analysis, ASPECTS < 6 (OR 3.673, p = 0.041), and amount of contrast injected ≥ 140 ml (OR 5.412, p = 0.003) were independent predictors of sICH, but not any more baseline glucose > 11.1 mmol/L (OR 1.467, p = 0.584), CrCl ≤ 30 ml/min/1.73 (OR 4.177, p = 0.069), acute ICA occlusion (OR 2.079, p = 0.181), stent implantation (OR 0.465, p = 0.512), tirofiban use (OR 5.164, p = 0.167), and time from onset-to-groin puncture (OR 1.453, p = 0.514).
The amount of contrast medium used is a modifiable factor associated with sICH. This association is novel and may be related to the neurotoxicity of the contrast medium disrupting the blood-brain barrier.
尽管技术有所改进且介入后护理更加精细，但症状性颅内出血（sICH）仍是机械取栓术（MT）最令人担忧的并发症。基于围介入期参数，我们旨在找出哪些患者发生sICH的风险更高。
回顾性分析2017年3月至2020年3月期间连续收治的急性缺血性卒中（AIS）且确诊为大血管闭塞并接受MT的患者。对人口统计学、临床、放射学变量以及取栓术特有的参数进行了回顾。进行单因素分析，并将具有统计学意义的变量纳入逻辑回归模型，以确定预测sICH的独立因素。
共纳入236例确诊为大血管闭塞的患者，其中22例（9.3%）发生了sICH。sICH的单因素预测指标包括糖尿病、血糖>11.1 mmol/L、肌酐清除率（CrCl）≤30 ml/min/1.73、提示治疗前梗死灶大小的ASPECTS评分、急性颈内动脉（ICA）闭塞、支架植入、替罗非班的使用、症状发作至腹股沟穿刺的时间>4.5小时以及造影剂用量高。在多因素分析中，ASPECTS评分<6（比值比[OR] 3.673，p = 0.041）和造影剂注射量≥140 ml（OR 5.412，p = 0.003）是sICH的独立预测因素，但基线血糖>11.1 mmol/L（OR 1.467，p = 0.584）、CrCl≤30 ml/min/1.73（OR 4.177，p = 0.069）、急性ICA闭塞（OR 2.079，p = 0.181）、支架植入（OR 0.465，p = 0.512）、替罗非班的使用（OR 5.164，p = 0.167）以及症状发作至腹股沟穿刺的时间（OR 1.453，p = 0.514）不再是独立预测因素。
造影剂的使用量是与sICH相关的一个可改变因素。这种关联是新发现的，可能与造影剂破坏血脑屏障的神经毒性有关。
