急性缺血性脑卒中血管内治疗后立即行双能 CT 检查发现颅内出血的预后意义。
Prognostic implications of intracranial haemorrhage on dual-energy CT immediately following endovascular treatment for acute ischemic stroke.
机构信息
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
出版信息
J Neuroradiol. 2024 Jun;51(4):101168. doi: 10.1016/j.neurad.2023.11.003. Epub 2023 Nov 19.
OBJECTIVE
To describe the incidence, risk factors, and prognostic relevance of intracranial haemorrhage (ICH) immediately after endovascular treatment (EVT) for ischaemic stroke in the anterior circulation.
METHODS
EVT records from 2010 to 2019 were screened. Included patients underwent DECT within 3h post-EVT. Virtual native reconstructions were evaluated for ICH according to the Heidelberg criteria and grouped into Heidelberg classes (HCs): [HC1] haemorrhagic infarction (HI)1, HI2 and parenchymal haematoma (PH)1; [HC2] PH2; [HC3] i.a. intraventricular and subarachnoid haemorrhage. If ICH corresponding to multiple HCs was observed, we assumed that the (largest) parenchymal ICH would have the greatest prognostic impact. Hence, a single HC was attributed by the following order of severity: HC2, HC1, HC3. The primary outcome was the modified Rankin Scale (mRS) at 90 days. The effect of asymptomatic ICH (aICH) and symptomatic ICH (sICH) of (1) HC1 or HC2 and (2) HC3 on patient outcomes was evaluated with multivariable regression after multiple imputation.
RESULTS
Out of 651 records, 498 patients were included. Eighty-one (16%) patients showed ICH on post-EVT DECT, of which 19 were classified as HC1 (21% symptomatic), 6 as HC2 (100% symptomatic), and 56 as HC3 (14% symptomatic). ICH development was mainly associated with unfavourable procedural characteristics. Both aICH and sICH of HC1 or HC2 were associated with the mRS (aICH: adjusted [a]cOR 4.92, 95%CI [1.48-16.35]; sICH: acOR 12.97, 95%CI [2.39-70.26]) and mortality (aICH: aOR 10.08, 95%CI [2.48-40.88]; sICH: aOR 9.92, 95%CI [1.48-66.31]). Likewise, sICH of HC3 was associated with the mRS and mortality (acOR 19.91, 95%CI [4.03-98.35], and aOR 13.23, 95%CI [2.27-77.18], respectively). aICH of HC3 was not significantly associated with the mRS or mortality (acOR 0.87, 95%CI [0.48-1.57], and cOR 0.84, 95%CI [0.32-2.20], respectively).
CONCLUSIONS
Immediate post-EVT ICH is a frequent finding. Except for aICH of HC3, any ICH is associated with poor long-term clinical outcomes.
目的
描述前循环缺血性脑卒中血管内治疗（EVT）后即刻颅内出血（ICH）的发生率、风险因素和预后相关性。
方法
筛选 2010 年至 2019 年的 EVT 记录。纳入的患者在 EVT 后 3 小时内行双能量 CT（DECT）检查。根据海德堡标准对虚拟原始重建图像进行评估，分为海德堡分级（HC）：[HC1]出血性梗死（HI）1、HI2 和实质血肿（PH）1；[HC2]PH2；[HC3]脑室内和蛛网膜下腔出血。如果观察到多个 HC 的 ICH，则假定（最大）实质 ICH 具有最大的预后影响。因此，按严重程度的以下顺序归因于单个 HC：HC2、HC1、HC3。主要结局为 90 天改良 Rankin 量表（mRS）评分。采用多元回归分析和多重插补法，评估无症状性 ICH（aICH）和症状性 ICH（sICH）[1]HC1 或 HC2 和[2]HC3 对患者预后的影响。
结果
在 651 份记录中，纳入了 498 名患者。81 名（16%）患者在 EVT 后 DECT 上显示 ICH，其中 19 例为 HC1（21%症状性），6 例为 HC2（100%症状性），56 例为 HC3（14%症状性）。ICH 发生主要与不良的手术特征有关。HC1 或 HC2 的 aICH 和 sICH 均与 mRS 相关（aICH：校正[ac]OR 4.92，95%CI [1.48-16.35]；sICH：acOR 12.97，95%CI [2.39-70.26]）和死亡率（aICH：aOR 10.08，95%CI [2.48-40.88]；sICH：aOR 9.92，95%CI [1.48-66.31]）。同样，HC3 的 sICH 与 mRS 和死亡率相关（acOR 19.91，95%CI [4.03-98.35]和 aOR 13.23，95%CI [2.27-77.18]）。HC3 的 aICH 与 mRS 或死亡率无显著相关性（acOR 0.87，95%CI [0.48-1.57]和 cOR 0.84，95%CI [0.32-2.20]）。
结论
EVT 后即刻 ICH 是一种常见的发现。除 HC3 的 aICH 外，任何 ICH 均与长期临床预后不良相关。
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