Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M., D.M.), Beijing Tiantan Hospital, Capital Medical University, China.
Department of Neurology, Morsani College of Medicine (W.S.B.), University of South Florida, Tampa.
Stroke. 2022 Jun;53(6):1984-1992. doi: 10.1161/STROKEAHA.121.037411. Epub 2022 Mar 31.
The role of stroke etiology subtype in patients with acute large vessel occlusion on the occurrence of hemorrhagic transformation (HT) after endovascular treatment is poorly studied, and which factors mediate their relationship remains largely unknown. We utilized nationwide registry data to explore the association of stroke subtype (cardioembolism versus large artery atherosclerosis) with HT and to identify the possible mediators.
A total of 1015 subjects were selected from the ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke)-a prospective consecutive cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals in China between November 2017 and March 2019-and divided into large artery atherosclerosis (n=538) and cardioembolism (n=477) according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The types of HT included any intracerebral hemorrhage (ICH), parenchymal hematoma, and symptomatic ICH within 24 hours after endovascular treatment. The association between stroke subtype and HT was analyzed using a logistic regression model. Mediation analysis was done to assess how much of the effect of stroke subtype on HT was mediated through the identified mediators.
Stroke subtype (cardioembolism versus large artery atherosclerosis) was associated with increased risk of any ICH (29.8% versus 16.5%; odds ratio, 2.03 [95% CI, 1.22-3.36]), parenchymal hematoma (14.3% versus 5.4%; odds ratio, 2.90 [95% CI, 1.38-6.13]), and symptomatic ICH (9.9% versus 4.7%; odds ratio, 2.59 [95% CI, 1.09-6.16]) after adjustment for potential confounders. The more thrombectomy passes in cardioembolism patients had a significant mediation effect on the association of stroke subtype with increased risk of HT (any ICH, 15.9%; parenchymal hematoma, 13.4%; symptomatic ICH, 14.2%, respectively).
Stroke subtype is an independent risk factor for HT within 24 hours following endovascular treatment among acute large vessel occlusion patients. Mediation analyses propose that stroke subtype contributes to HT partly through thrombectomy pass, suggesting a possible pathomechanistic link.
URL: https://www.
gov; Unique identifier: NCT03370939.
在接受血管内治疗的急性大血管闭塞患者中，卒中病因亚型在出血性转化（HT）发生中的作用研究甚少，其相关因素也知之甚少。本研究利用全国性登记数据，探讨了卒中亚型（心源性栓塞与大动脉粥样硬化）与 HT 的关系，并确定了可能的中介因素。
从 ANGEL-ACT 登记研究（急性缺血性卒中血管内治疗的关键技术和急救工作流程改进）中选取了 1015 名患者，该研究为 2017 年 11 月至 2019 年 3 月期间在中国 111 家医院接受血管内治疗的急性大血管闭塞患者的前瞻性连续队列研究。根据试验 OF ORG 10172 在急性脑卒中治疗标准，将患者分为大动脉粥样硬化（n=538）和心源性栓塞（n=477）。HT 类型包括血管内治疗后 24 小时内任何颅内出血（ICH）、脑实质血肿和症状性 ICH。采用 logistic 回归模型分析卒中亚型与 HT 的关系。采用中介分析评估卒中亚型对 HT 的影响有多少是通过已确定的中介因素介导的。
卒中亚型（心源性栓塞与大动脉粥样硬化）与任何 ICH（29.8%比 16.5%；优势比，2.03[95%CI，1.22-3.36]）、脑实质血肿（14.3%比 5.4%；优势比，2.90[95%CI，1.38-6.13]）和症状性 ICH（9.9%比 4.7%；优势比，2.59[95%CI，1.09-6.16]）的风险增加相关，调整潜在混杂因素后差异仍有统计学意义。心源性栓塞患者的取栓次数越多，对卒中亚型与 HT 风险增加之间的关联有显著的中介作用（任何 ICH，15.9%；脑实质血肿，13.4%；症状性 ICH，14.2%）。
卒中亚型是急性大血管闭塞患者血管内治疗后 24 小时内 HT 的独立危险因素。中介分析表明，卒中亚型通过取栓次数部分导致 HT，提示可能存在一种发病机制联系。
gov；独特标识符：NCT03370939。
