Stroke Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain.
Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain.
Eur J Neurol. 2024 Feb;31(2):e16112. doi: 10.1111/ene.16112. Epub 2023 Nov 1.
In patients with acute ischaemic stroke (AIS), haemorrhagic transformation (HT) following endovascular treatment (EVT) is associated with poor functional outcome. However, the impact of asymptomatic HT, not linked to neurological deterioration in the acute phase, is unknown. We aimed to investigate the impact of asymptomatic PH1 (aPH1) and PH2 (aPH2) subtypes of HT on the functional outcome of patients treated with EVT.
We conducted a retrospective study of patients with AIS who were consecutively admitted to our comprehensive stroke centre between January 2019 and December 2022, and who underwent EVT. We collected clinical, radiological, and procedural data. HTs were categorized according to the Heidelberg classification. The primary outcome was the shift on the modified Rankin Scale (mRS) at 3 months of follow-up. We performed bivariate and multivariable ordinal regression analyses to test the association between aPH1/aPH2 and the primary outcome.
We included 314 patients (mean age = 72.5 years [SD = 13.6], 171 [54.5%] women). We detected 54 (17.2%) patients with HT; 23 (7.3%) were classified as PH2 (11 asymptomatic) and 17 (5.4%) as PH1 (16 asymptomatic). The adjusted common odds ratio for aPH2 of worsening 1 point on the 3-month mRS was 3.32 (95% confidence interval = 1.16-9.57, p = 0.026). No association was observed for aPH1. aPH2 was also independently associated with lower odds of achieving a favourable outcome (mRS = 0-2). Neither aPH1 nor aPH2 was associated with mortality.
In patients with AIS treated with EVT, aPH2 is independently associated with unfavourable functional outcome.
在急性缺血性脑卒中（AIS）患者中，血管内治疗（EVT）后发生的出血性转化（HT）与不良的功能结局相关。然而，与急性期神经功能恶化无关的无症状 HT 的影响尚不清楚。我们旨在研究 EVT 治疗的患者中无症状 PH1（aPH1）和 PH2（aPH2）亚型 HT 对功能结局的影响。
我们对 2019 年 1 月至 2022 年 12 月连续入住我们综合卒中中心并接受 EVT 的 AIS 患者进行了回顾性研究。我们收集了临床、影像学和程序数据。HT 根据海德堡分类进行分类。主要结局是 3 个月随访时改良 Rankin 量表（mRS）的变化。我们进行了双变量和多变量有序回归分析，以检验 aPH1/aPH2 与主要结局之间的关系。
我们纳入了 314 名患者（平均年龄 72.5 岁[标准差 13.6]，171 名[54.5%]女性）。我们检测到 54 名（17.2%）患者发生 HT；23 名（7.3%）为 PH2（11 例无症状），17 名（5.4%）为 PH1（16 例无症状）。3 个月 mRS 恶化 1 分的 aPH2 调整后常见比值比为 3.32（95%置信区间 1.16-9.57，p=0.026）。aPH1 无相关性。aPH2 也与获得良好结局（mRS=0-2）的可能性较低独立相关。aPH1 和 aPH2 均与死亡率无关。
在接受 EVT 治疗的 AIS 患者中，aPH2 与不良的功能结局独立相关。
