机械取栓治疗急性缺血性卒中后颅内出血的危险因素和预测因素：来自卒中取栓和动脉瘤注册研究（STAR）的见解。
Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR).
机构信息
Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
出版信息
J Neurointerv Surg. 2023 Nov;15(e2):e312-e322. doi: 10.1136/jnis-2022-019513. Epub 2023 Feb 1.
BACKGROUND
Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy.
METHODS
This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade.
RESULTS
The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference.
CONCLUSIONS
This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.
背景
降低颅内出血（ICH）可以改善急性缺血性卒中（AIS）介入治疗患者的预后。我们旨在确定 AIS 取栓术后 ICH 的危险因素。
方法
这是对卒中取栓和动脉瘤登记（STAR）数据库的回顾性研究。所有接受 AIS 取栓术且有 ICH 数据的患者均纳入研究。采用多变量回归模型确定取栓术后 ICH 的预测因素。根据症状状态和欧洲合作急性卒中研究（ECASS）分级进行亚组分析。
结果
研究队列包括 6860 例患者。任何 ICH 和症状性 ICH（sICH）的发生率分别为 25%和 7%。根据 ECASS 分级，出血性梗死 1 型（HI1）发生率为 36%，HI2 为 24%，实质内出血 1 型（PH1）为 22%，PH2 为 17%。术中并发症独立预测任何 ICH（OR 3.8083，P<0.0001）、PH1（OR 1.9053，P=0.0195）和 PH2（OR 2.7347，P=0.0004）。种族也独立预测任何 ICH（黑人：OR 0.5180，P=0.0017；西班牙裔：OR 0.4615，P=0.0148）、sICH（非白人：OR 0.4349，P=0.0107）、PH1（非白人：OR 3.1668，P<0.0001）和 PH2（非白人：OR 1.8689，P=0.0176），以白人作为参考。原发性机械取栓技术也独立预测 ICH。ADAPT（直接抽吸首次通过技术）是 sICH 的负预测因子（OR 0.2501，P<0.0001），支架取栓作为参考。
结论
本研究使用真实世界数据确定了 AIS 取栓术后 ICH 的危险因素。直接抽吸术降低 sICH 风险的趋势更为明显。术中并发症和种族是任何 ICH、sICH、PH1 和 PH2 分类中预测因子的一致性。需要进一步研究技术和种族对 AIS 取栓术后 ICH 和结局的影响。
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