Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and University Hospital Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, Central Military Hospital Prague, Czech Republic.
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and University Hospital Olomouc, Czech Republic.
J Stroke Cerebrovasc Dis. 2024 Sep;33(9):107852. doi: 10.1016/j.jstrokecerebrovasdis.2024.107852. Epub 2024 Jul 8.
Endovascular treatment (EVT) of tandem lesion (TL) in the anterior circulation acute ischemic stroke (IS) usually requires periprocedural antithrombotic treatment and early initiation of dual antiplatelet therapy (DAPT) after carotid stenting. However, it may contribute to an occurrence of symptomatic intracerebral hemorrhage (SICH) in some cases. We investigated factors influencing the SICH occurrence and assessed the possible predictors of SICH after EVT.
IS patients with TL in the anterior circulation treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and recanalization using the TICI scale. SICH was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of SICH with adjustment for potential confounders.
In total, 300 (68.7 % males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7 %) patients and 176 (58.7 %) had mRS 0-2. SICH occurred in 25 (8.3 %) patients. Patients with SICH did not differ from those without SICH in the rate of periprocedural antithrombotic treatment (64 vs. 57.5 %, p = 0.526) and in the rate of DAPT started within the first 12 h after EVT (20 vs. 42.2 %, p = 0.087). After adjustment, admission NIHSS and admission glycemia were found as the only predictors of SICH after EVT.
Admission NIHSS and glycemia were found as the only predictors of SICH after EVT for TL. No associations between periprocedural antithrombotic treatment, early start of DAPT after EVT and SICH occurrence were found.
在急性缺血性脑卒中（IS）的前循环中，串联病变（TL）的血管内治疗（EVT）通常需要在经皮血管成形术期间进行抗血栓治疗，并在颈动脉支架置入术后早期开始双联抗血小板治疗（DAPT）。然而，在某些情况下，这可能导致症状性颅内出血（SICH）的发生。我们研究了影响 SICH 发生的因素，并评估了 EVT 后 SICH 的可能预测因素。
本研究纳入了接受 EVT 治疗的前循环 TL 的 IS 患者，该研究为多中心回顾性 ASCENT 研究。改良 Rankin 量表（mRS）评分为 0-2 分和 TICI 分级的再通被定义为 3 个月的良好临床结局。采用 SITS-MOST 标准评估 SICH。使用逻辑回归分析，在调整潜在混杂因素后，评估 SICH 的可能预测因素。
共纳入 300 例（68.7%为男性，平均年龄 67.3±10.2 岁）患者，入院时 NIHSS 中位数为 17。290 例（96.7%）患者实现了再通（TICI 2b-3），176 例（58.7%）患者 mRS 评分为 0-2。25 例（8.3%）患者发生 SICH。发生 SICH 的患者与未发生 SICH 的患者在经皮血管成形术期间抗血栓治疗的比例（64% vs. 57.5%，p=0.526）和 EVT 后 12 小时内开始 DAPT 的比例（20% vs. 42.2%，p=0.087）均无差异。调整后，入院 NIHSS 和入院血糖被发现是 EVT 后 SICH 的唯一预测因素。
入院 NIHSS 和血糖是 EVT 治疗 TL 后 SICH 的唯一预测因素。经皮血管成形术期间的抗血栓治疗、EVT 后早期开始 DAPT 与 SICH 发生之间无关联。
