Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Finland (J.J.V., M.K.).
Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland (D.S., J.P.).
Stroke. 2022 Dec;53(12):3616-3621. doi: 10.1161/STROKEAHA.122.040151. Epub 2022 Oct 18.
Intravenous thrombolysis seems safe in acute ischemic stroke patients with saccular, unruptured intracranial aneurysms (UIAs), but little is known about the differences in cardiovascular risk factors and outcomes between intravenous thrombolysis-treated stroke patients with and without UIAs. We hypothesized that UIA patients would have a higher burden of cardiovascular risk factors and, therefore, a higher risk of an unfavorable outcome.
In this prospective cohort study conducted in Helsinki University Hospital, we identified intravenous thrombolysis-treated patients with concurrent saccular UIAs admitted to a comprehensive stroke center between 2005 and 2019 using 2 overlapping methods. For each UIA patient, a control patient was identified and matched (1:1) for age, sex, admission year, and stroke severity. The primary outcome was an unfavorable outcome at 3 months, defined as a modified Rankin Scale (mRS) score 3 to 6. The secondary outcomes were an excellent outcome (mRS score 0-1) at 3 months and mRS difference in shift analysis.
In total, 118 UIA patients and 118 matched control patients were identified. The UIA patients were more often current smokers, and their admission systolic blood pressure was higher. The rate of hemorrhagic complications did not differ between the groups. UIAs were not associated with an unfavorable outcome in the conditional logistic regression analysis (odds ratio, 1.41 [95% CI, 0.79-2.54]; =0.25). However, the UIA patients were less likely to have excellent outcomes (odds ratio for non-excellent outcome, 2.09 [95% CI, 1.13-3.85]; =0.02). In shift analysis, UIAs were associated with higher mRS (odds ratio, 1.61 [95% CI, 1.03-2.49]; =0.04).
The intravenous thrombolysis-treated stroke patients with UIAs were more often current smokers and had higher systolic blood pressure than the matched patients without UIAs. They were as likely to have unfavorable outcomes at 3 months but seemed less likely to achieve excellent outcomes and were more likely to have higher mRS in shift analysis.
急性缺血性脑卒中患者并发囊状未破裂颅内动脉瘤（UIAs）时，静脉溶栓似乎是安全的，但对于静脉溶栓治疗的伴有和不伴有 UIAs 的脑卒中患者在心血管危险因素和结局方面的差异知之甚少。我们假设 UIA 患者会有更高的心血管危险因素负担，因此，不良结局的风险更高。
在这项在赫尔辛基大学医院进行的前瞻性队列研究中，我们使用了两种重叠的方法，确定了 2005 年至 2019 年间在综合卒中中心接受静脉溶栓治疗且并发囊状 UIA 的患者。对于每例 UIA 患者，均选择了一名匹配患者（1:1 配对），匹配年龄、性别、入院年份和卒中严重程度。主要结局是 3 个月时的不良结局，定义为改良 Rankin 量表（mRS）评分 3 至 6。次要结局是 3 个月时的良好结局（mRS 评分 0-1）和 mRS 差值移位分析。
共纳入 118 例 UIA 患者和 118 例匹配的对照组患者。UIA 患者中，当前吸烟者更多，入院时的收缩压更高。两组的出血性并发症发生率无差异。在条件逻辑回归分析中，UIA 与不良结局无关（比值比，1.41 [95% CI，0.79-2.54]；=0.25）。然而，UIA 患者不太可能有良好的结局（非良好结局的比值比，2.09 [95% CI，1.13-3.85]；=0.02）。在移位分析中，UIA 与更高的 mRS 相关（比值比，1.61 [95% CI，1.03-2.49]；=0.04）。
与未匹配的无 UIA 的患者相比，接受静脉溶栓治疗的伴有 UIA 的脑卒中患者中，当前吸烟者更多，收缩压更高。他们在 3 个月时发生不良结局的可能性相同，但似乎不太可能获得良好结局，且在移位分析中 mRS 更高的可能性更大。
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