Reda Abdullah, Hasanzadeh Alireza, Ghozy Sherief, Sanjari Moghaddam Hossein, Adl Parvar Tanin, Motevaselian Mohsen, Kadirvel Ramanathan, Kallmes David F, Rabinstein Alejandro
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA.
Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA.
Brain Sci. 2025 Jan 11;15(1):63. doi: 10.3390/brainsci15010063.
Symptomatic intracranial hemorrhage (sICH) is the most dreaded complication after reperfusion therapy for acute ischemic stroke. We performed a meta-analysis of randomized controlled trials to estimate and compare risks of sICH after mechanical thrombectomy (MT) depending on the location of the large vessel occlusion, concomitant use of intravenous thrombolysis, timing of treatment, and core size.
Randomized controlled trials were included, following a comprehensive search of different databases from inception to 1 March 2024. Random-effect models in a meta-analysis were employed to obtain the pooled risk ratios (RRs) and their corresponding 95% confidence intervals (95% CI) for sICH with MT, and were then compared to other reperfusion treatment regimens, including best medical treatment and intravenous thrombolysis (IVT).
MT in the anterior circulation was associated with a significantly higher risk of sICH as compared with no-MT (RR: 1.46; 95%CI: 1.03-2.07; = 0.037). The risk of sICH was comparable between the MT and MT+IVT groups (RR: 0.77; 95%CI: 0.57-1.03; 0.079). There was no difference in sICH risk with MT as compared with no-MT within 6 h of last known well (RR: 1.14; 95%CI: 0.78-1.66; = 0.485) and beyond that time (RR: 1.29; 95%CI: 0.80-2.08; = 0.252); the risk of sICH was also comparable between MT conducted within 6 h of last known well and MT conducted beyond that time ( = 0.512). The sICH risk for MT in the posterior circulation (RR: 7.48; 95%CI: 2.27-24.61) was significantly higher than for MT in the anterior circulation (RR: 1.18; 95%CI: 0.90-1.56) ( = 0.003). MT was also associated with a significantly higher sICH risk than no-MT among patients with large core strokes (RR: 1.71; 95%CI: 1.09-2.66, = 0.018).
When evaluating cumulative evidence from randomized controlled trials, the risk of sICH is increased after MT compared with patients not treated with MT. Yet, the difference is largely driven by the greater risk of sICH in patients treated with MT for posterior circulation occlusions and, to a lesser degree, large core strokes. Concomitant use of intravenous thrombolysis and the use of MT in the extended therapeutic window do not raise the risk of sICH.
症状性颅内出血（sICH）是急性缺血性卒中再灌注治疗后最可怕的并发症。我们进行了一项随机对照试验的荟萃分析，以评估和比较机械取栓（MT）后sICH的风险，该风险取决于大血管闭塞的位置、静脉溶栓的联合使用、治疗时机和梗死核心大小。
纳入自数据库建立至2024年3月1日全面检索不同数据库后的随机对照试验。荟萃分析中采用随机效应模型来获得MT治疗sICH的合并风险比（RRs）及其相应的95%置信区间（95%CI），然后与其他再灌注治疗方案进行比较，包括最佳药物治疗和静脉溶栓（IVT）。
与未进行MT相比，前循环MT发生sICH的风险显著更高（RR：1.46；95%CI：1.03 - 2.07；P = 0.037）。MT组和MT + IVT组之间sICH的风险相当（RR：0.77；95%CI：0.57 - 1.03；P = 0.079）。与最后一次已知状态良好后6小时内未进行MT相比，MT发生sICH的风险无差异（RR：1.14；95%CI：0.78 - 1.66；P = 0.485），6小时以后也是如此（RR：1.29；95%CI：0.80 - 2.08；P = 0.252）；最后一次已知状态良好后6小时内进行的MT与6小时以后进行的MT之间sICH的风险也相当（P = 0.512）。后循环MT发生sICH的风险（RR：7.48；95%CI：2.27 - 24.61）显著高于前循环MT（RR：1.18；95%CI：0.90 - 1.56）（P = 0.003）。在梗死核心大的患者中，MT发生sICH的风险也显著高于未进行MT的患者（RR：1.71；95%CI：1.09 - 2.66，P = 0.018）。
在评估随机对照试验的累积证据时，与未接受MT治疗的患者相比，MT后sICH的风险增加。然而，这种差异在很大程度上是由后循环闭塞接受MT治疗的患者中sICH风险更高以及梗死核心大的患者中sICH风险稍高所驱动的。静脉溶栓的联合使用以及在延长治疗窗内使用MT不会增加sICH的风险。
