Bagnato Maria Rosaria, Maestrini Ilaria, Bruno Leonardo, Ciullo Ilaria, D'Agostino Federica, Lacidogna Giordano, Marrama Federico, Mascolo Alfredo Paolo, Rocco Alessandro, Diomedi Marina
Stroke Center, Department of Systems Medicine, University Hospital of Rome 'Tor Vergata', Rome, Italy.
Stroke Center, Department of Systems Medicine, University Hospital of Rome 'Tor Vergata', Viale Oxford 81, Rome 00133, Italy.
Ther Adv Neurol Disord. 2024 Oct 21;17:17562864241289735. doi: 10.1177/17562864241289735. eCollection 2024.
The predictors of intracranial haemorrhagic transformation (HT) in acute ischaemic stroke (AIS) patients undergoing dual antiplatelet therapy (DAPT) are not well known.
The aim of this study is to identify the possible clinical and radiological predictors of HT in patients, irrespective of clinical indication for this treatment.
This study is a monocentric cohort retrospective study.
We enrolled consecutive AIS patients, from our prospective register, admitted to Stroke Unit between June 2021 and June 2023 undergoing DAPT with Acetylsalicylic Acid and Clopidogrel within 72 h from symptoms onset. According to current guidelines, DAPT indication was for patients with a minor stroke, symptomatic intracranial artery stenosis and carotid angioplasty stenting. We collected clinical, demographical and radiological data. We used ABC/2 method to measure stroke volume in magnetic resonance imaging (MRI)/Diffusion-weighted imaging (DWI) sequences performed within 48 h. The primary outcome was the presence of HT at non-contrast brain computed tomography, performed 7 days after commencing DAPT.
One hundred ninety-four patients were included. Twenty-eight (14.4%) presented HT. Higher NIH Stroke Scale (NIHSS) and MRI/DWI lesion volume related to increased risk of HT ( < 0.001). Reperfusion therapy and mechanical thrombectomy (MT), stent placement and a loading dose (LD) of dual antiplatelet or Clopidogrel were associated with a higher occurrence of HT ( < 0.05). Furthermore, we individuated an NIHSS cut-off value >4 (area under the curve (AUC) 0.80, sensitivity 0.82, specificity 0.65) and a volume cut-off value >8.2 ml (AUC 0.82, sensitivity 0.79, specificity 0.80) associated with an increased risk of HT (respectively, adjusted odds ratio (adj. OR) 6.5, confidence interval (CI) 1.3-32.7, = 0.024 and adj. OR 11.0, CI 3.1-39.2, < 0.001).
In clinical practice, MT treatment, antiplatelet LD administration, stent placement and clinical severity may relate to a higher risk of HT in patients with AIS and DAPT in the acute phase. In particular, we found that lesion volume cut-off could help to identify patients at greater risk of HT, regardless of the indication for DAPT.
接受双重抗血小板治疗（DAPT）的急性缺血性卒中（AIS）患者发生颅内出血性转化（HT）的预测因素尚不清楚。
本研究旨在确定患者HT可能的临床和影像学预测因素，无论该治疗的临床适应症如何。
本研究为单中心队列回顾性研究。
我们纳入了2021年6月至2023年6月期间连续入住卒中单元的AIS患者，这些患者来自我们的前瞻性登记册，在症状发作后72小时内接受了阿司匹林和氯吡格雷的DAPT治疗。根据当前指南，DAPT适用于轻度卒中、症状性颅内动脉狭窄和颈动脉血管成形术支架置入术患者。我们收集了临床、人口统计学和影像学数据。我们使用ABC/2方法在48小时内进行的磁共振成像（MRI）/扩散加权成像（DWI）序列中测量卒中体积。主要结局是在开始DAPT治疗7天后进行的非增强脑部计算机断层扫描中HT的存在情况。
共纳入194例患者。28例（14.4%）出现HT。较高的美国国立卫生研究院卒中量表（NIHSS）评分和MRI/DWI病变体积与HT风险增加相关（<0.001）。再灌注治疗和机械取栓（MT）、支架置入以及双重抗血小板或氯吡格雷的负荷剂量（LD）与HT的较高发生率相关（<0.05）。此外，我们确定NIHSS临界值>4（曲线下面积（AUC）为0.80，敏感性为0.82，特异性为0.65）和体积临界值>8.2 ml（AUC为0.82，敏感性为0.79，特异性为0.80）与HT风险增加相关（调整后的优势比（adj. OR）分别为6.5，置信区间（CI）为1.3 - 32.7，P = 0.024和adj. OR为11.0，CI为3.1 - 39.2，P < 0.001）。
在临床实践中，MT治疗、抗血小板LD给药、支架置入和临床严重程度可能与急性期接受DAPT的AIS患者发生HT的较高风险相关。特别是，我们发现病变体积临界值有助于识别HT风险较高的患者，无论DAPT的适应症如何。
