Ancelet Claire, Neveü Sophie, Venditti Laura, Cortese Jonathan, Chassin Oliver, Pelissou Coralie, Berthou Elsa Talab, Babin Matthias, Nasser Ghaidaa, Benoudiba Farida, Legris Nicolas, Rivière Mariana Sarov, Chausson Nicolas, Spelle Laurent, Denier Christian
Diagnostic and Interventional Neuroradiology Department, NEURI Brain Vascular Center, Bicêtre University-Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Department of Neurology, Hôpital Bicêtre, Stroke Center, 78 Rue du General Leclerc, 94270, Le Kremlin Bicêtre, France.
J Neurol. 2023 Nov;270(11):5493-5501. doi: 10.1007/s00415-023-11886-w. Epub 2023 Jul 29.
Hemorrhagic transformation (HT) is an uncommon complication of posterior circulation acute ischemic stroke (PCS) compared to anterior circulation stroke. Nevertheless, it remains a major concern especially following reperfusion therapy. This study aimed at identifying potential predictive factors associated with HT in PCS.
Consecutive patients, from a multicenter cohort, with PCS treated by IVT or EVT or the combination of both, were included from December 2015 to May 2019. The European Cooperative Acute Stroke Study criteria was used to identify HT. Potential risk factors were analyzed using univariate and multivariable testing models.
A total of 96 patients were included in our study. Median age was 66 (57-83) years, 54 patients (56%) were male and median baseline NIHSS was 8 (4-14). 77 patients (80%) received IVT and 54 patients (56%) benefited from EVT. HT occurred in 19 patients (20%), while sHT occurred in 3 patients (3%). HT was found to be associated with poor functional status at 3 months in univariate analysis (p = 0.0084). Multivariable analysis confirmed that higher baseline NIHSS (OR 1.1008; 95% CI [1.0216-1.1862]; p = 0.0117) and lobar topography of ischemia (OR 4.4275; 95% CI [1.3732-14.2753]; p = 0.0127) were independent predictors of the occurrence of HT.
HT is associated with increased morbidity in patients with PCS; higher NIHSS and lobar ischemia were independent predictors of HT in our population. Easy-to-use predictive markers may help to tailor therapeutic management of patients with PCS.
与前循环卒中相比，出血性转化（HT）是后循环急性缺血性卒中（PCS）的一种罕见并发症。然而，它仍然是一个主要问题，尤其是在再灌注治疗之后。本研究旨在确定与PCS中HT相关的潜在预测因素。
纳入2015年12月至2019年5月期间来自多中心队列、接受静脉溶栓（IVT）或血管内治疗（EVT）或两者联合治疗的连续PCS患者。采用欧洲急性卒中协作研究标准来确定HT。使用单变量和多变量测试模型分析潜在危险因素。
我们的研究共纳入96例患者。中位年龄为66（57 - 83）岁，54例患者（56%）为男性，基线美国国立卫生研究院卒中量表（NIHSS）中位数为8（4 - 14）。77例患者（80%）接受了IVT，54例患者（56%）接受了EVT。19例患者（20%）发生了HT，其中症状性HT发生在3例患者（3%）中。单变量分析发现HT与3个月时的功能状态差相关（p = 0.0084）。多变量分析证实，较高的基线NIHSS（比值比[OR]1.1008；95%置信区间[CI][1.0216 - 1.1862]；p = 0.0117）和缺血的叶性部位（OR 4.4275；95% CI[1.3732 - 14.2753]；p = 0.0127）是HT发生的独立预测因素。
HT与PCS患者的发病率增加相关；较高的NIHSS和叶性缺血是我们研究人群中HT的独立预测因素。易于使用的预测标志物可能有助于调整PCS患者的治疗管理。
