Li Jinrui, Cheng Kailin, Ke Jianxia, Li Jintao, Wen Jia, Chen Junting, Jia Xue, Fu Xiaoli, Lv Kefeng, Shi Zhu
1(st) school of clinical medicine, Southern Medical University, China; Stroke center and Department of Neurology, 10(th) Affiliate Hospital of Southern Medical University, China.
Stroke center and Department of Neurology, 10(th) Affiliate Hospital of Southern Medical University, China; Guangdong Medical University, China.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108175. doi: 10.1016/j.jstrokecerebrovasdis.2024.108175. Epub 2024 Dec 6.
Asymptomatic intracranial hemorrhage (aICH) is common after endovascular thrombectomy (EVT). Collateral circulation could modify the association between aICH with functional outcome and we aimed to investigate the impact of systemic inflammation index on 3-month outcome under different collateral circulation.
Consecutive patients undertaken EVT were enrolled and classified into non-intracranial hemorrhage (non-ICH), aICH and symptomatic intracranial hemorrhage (sICH) groups according to the neurological status and National Institutes of Health Stroke Scale (NIHSS) changes within 72 hours after EVT. Preoperative collateral status was scored using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Clinical data were collected and analyzed according to the stratification of collateral stratification. Multivariate regression models were constructed to evaluate the influence of systemic inflammation indexes and collateral status on functional outcome.
Of 302 patients, 86 (28.5%) developed aICH with 36(11.9%) sICH. Compared to non-ICH patients, there was a significant trend towards higher proportion of poor collateral circulation in patients with aICH, sICH (47.8% vs. 67.2% vs. 94.4%, p <0.001). Spearman's correlation analysis revealed a significant negative correlation of peripheral neutrophil counts, NLR, and SIRI with collateral circulation score. Under poor collateral circulation, neutrophil counts showed a significant positive association with sICH (OR 1.20, 95%CI: 1.07-1.35, p=0.002), but not with aICH. Under good collateral circulation, the inflammation indexes did not show a significant correlation with either ICH.
aICH patients with good collateral circulation have good functional outcome comparable to no-ICH patients. Under poor collateral circulation, elevated neutrophil counts may contribute to the conversion from aICH to sICH. Tailored anti-inflammatory therapy has potential to improve the efficacy and safety of EVT.
血管内血栓切除术（EVT）后无症状颅内出血（aICH）很常见。侧支循环可能会改变aICH与功能结局之间的关联，我们旨在研究全身炎症指标在不同侧支循环情况下对3个月结局的影响。
纳入接受EVT的连续患者，并根据EVT后72小时内的神经功能状态和美国国立卫生研究院卒中量表（NIHSS）变化分为非颅内出血（non-ICH）、aICH和症状性颅内出血（sICH）组。术前使用美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）量表对侧支循环状态进行评分。根据侧支循环分层收集和分析临床数据。构建多变量回归模型以评估全身炎症指标和侧支循环状态对功能结局的影响。
302例患者中，86例（28.5%）发生aICH，36例（11.9%）发生sICH。与non-ICH患者相比，aICH、sICH患者侧支循环不良的比例有显著升高趋势（47.8%对67.2%对94.4%，p<0.001）。Spearman相关性分析显示外周中性粒细胞计数、NLR和SIRI与侧支循环评分呈显著负相关。在侧支循环不良的情况下，中性粒细胞计数与sICH呈显著正相关（OR 1.20，95%CI：1.07-1.35，p=0.002），但与aICH无关。在侧支循环良好的情况下，炎症指标与任何一种ICH均无显著相关性。
侧支循环良好的aICH患者功能结局良好，与non-ICH患者相当。在侧支循环不良的情况下，中性粒细胞计数升高可能导致aICH转化为sICH。针对性的抗炎治疗有可能提高EVT的疗效和安全性。
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