Zhang Xiaoxi, Shen Fang, Rui Luo, Hanchen Liu, Shen Hongjian, Hongye Xu, Manyue Ge, Hua Weilong, Zhang Lei, Zhang Yongxin, Xing Pengfei, Li Zifu, Liu Jianmin, Yang Pengfei
Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Institutes of Brain Science, Fudan University, Shanghai, China.
J Neurointerv Surg. 2025 Jun 1;17(e2):e313-e319. doi: 10.1136/jnis-2024-022048.
The long-term follow-up of asymptomatic intracranial hemorrhage (aICH) in patients with acute ischemic stroke after endovascular treatment (EVT) remains controversial. O b j e c t i v e To evaluate the potential effect of aICH in a real-world practice setting using a matched prospective database.
This observational cohort study enrolled patients between January 2015 and December 2022 in a prospective database. Eligible patients with occlusions in the anterior circulation were given endovascular treatment and achieved successful reperfusion. The primary outcome was functional independence (modified Rankin Scale (mRS) score 0-2). Propensity score (PS)-weighted multivariable logistic regression analyses were adjusted and were repeated in subsequent 1:1 PS-matched cohorts.
732 patients, 516 without any ICH and 216 with aICH, were included. 418 and 348 patients were identified after matching in the aICH substudy and hemorrhagic infarction type aICH substudy, respectively. In the postmatched population, patients with aICH had worse functional outcomes (mRS score 0-2) at 90 days than patients without any ICH (37.8% vs 55.5%: P<0.001). Worse functional outcomes were seen in patients with aICH who were older (OR=5.59 (95% CI 2.91 to 10.74)), had higher baseline National Institutes of Health Stroke Scale score (OR=6.80 (95% CI 3.72 to 12.43)), lower baseline Alberta Stroke Program Early CT Score (OR=2.08 (95% CI 1.23 to 3.51)), and who received general anesthesia (OR=3.37 (95% CI 1.92 to 5.90)).
This matched-control study largely confirmed that asymptomatic ICH after EVT is associated with worse functional outcomes, and the harmful effect is more significant in older patients and those with severe baseline clinical and radiological features.
血管内治疗（EVT）后急性缺血性脑卒中患者无症状颅内出血（aICH）的长期随访仍存在争议。目的：使用匹配的前瞻性数据库评估aICH在实际临床环境中的潜在影响。
这项观察性队列研究纳入了2015年1月至2022年12月前瞻性数据库中的患者。符合条件的前循环闭塞患者接受血管内治疗并实现成功再灌注。主要结局是功能独立（改良Rankin量表（mRS）评分0 - 2）。进行倾向评分（PS）加权多变量逻辑回归分析，并在随后1:1 PS匹配队列中重复分析。
共纳入732例患者，其中516例无任何颅内出血，216例有aICH。aICH亚研究和出血性梗死型aICH亚研究分别匹配后确定了418例和348例患者。在匹配后的人群中，aICH患者在90天时的功能结局（mRS评分0 - 2）比无任何颅内出血的患者更差（37.8%对55.5%：P<0.001）。年龄较大（OR = 5.59（95%CI 2.91至10.74））以及美国国立卫生研究院卒中量表基线评分较高（OR = 6.80（95%CI 3.72至12.43））、阿尔伯塔卒中项目早期CT评分较低（OR = 2.08（95%CI 1.23至3.51））以及接受全身麻醉（OR = 3.37（95%CI 1.92至5.90））的aICH患者功能结局更差。
这项匹配对照研究在很大程度上证实，EVT后无症状颅内出血与更差的功能结局相关，且这种有害影响在老年患者以及具有严重基线临床和影像学特征的患者中更为显著。
