Cai Lingyu, Yan Zhizhong, Abdalkader Mohamad, Li Tianfang, Sang Hongfei, Tian Yan, Xie Dongjing, Li Maohua, Jin Wei, Albers Gregory W, Qiu Zhongming, Nguyen Thanh N, Yang Qingwu, Zhao Haojin, Jiang Shunfu
Neurology, The 903rd Hospital of the Chinese People's Liberation Army, Hangzhou, China.
Neurosurgery, The 904th Hospital of the Chinese People's Liberation Army, Wuxi, China.
Neurol Clin Pract. 2025 Aug;15(4):e200500. doi: 10.1212/CPJ.0000000000200500. Epub 2025 Jul 16.
Hemorrhagic transformation is a prevalent and serious complication that frequently occurs after endovascular recanalization in acute large vessel occlusion stroke. The impact of asymptomatic intracranial hemorrhage (aICH) on outcomes after endovascular thrombectomy (EVT) remains to be elucidated.
This was a pooled analysis of individual patient data of 2 randomized trials in China, the RESCUE BT trial from October 2018 to October 2021 and the Direct Endovascular Treatment for Large Vessel Occlusion Stroke trial from May 2018 to May 2020. Patients with acute anterior circulation large vessel occlusion were categorized into 3 groups based on CT or MRI examination within 48 hours after thrombectomy: no intracranial hemorrhage (no-ICH), aICH, and symptomatic ICH (sICH). The primary outcome was functional independence (defined as modified Rankin Scale score of 0-2) at 90 days. Secondary outcomes were the change in NIH Stroke Scale score from baseline to 5-7 days and 3-month mortality.
A total of 1,177 patients (median age, 68 years; 58.4% male) were included in this study, comprising 818 patients without ICH, 268 patients with aICH, and 91 patients with sICH. The proportion of functional independence was 57.3% in the no-ICH group, 34.7% in the aICH group, and 3.3% in the sICH group. Compared with the no-ICH group, there was a lower proportion of functional independence in the aICH group (adjusted odds ratio [aOR], 0.40; 95% CI 0.29-0.55; < 0.001) and the sICH group (aOR, 0.02; 95% CI 0.01-0.07; < 0.001). Both aICH and sICH were associated with less improvement of neurologic disability at 5-7 days from baseline and higher mortality at 90 days.
Among patients with large vessel occlusion stroke who underwent EVT, the presence of aICH was associated with less early neurologic improvement and greater disability at 90 days. Asymptomatic ICH should be assessed in EVT trials, and strategies to reduce asymptomatic hemorrhage should be investigated.
出血性转化是急性大血管闭塞性卒中血管内再通术后常见且严重的并发症。无症状颅内出血（aICH）对血管内血栓切除术（EVT）后预后的影响尚待阐明。
这是一项对中国两项随机试验的个体患者数据进行的汇总分析，即2018年10月至2021年10月的RESCUE BT试验以及2018年5月至2020年5月的大血管闭塞性卒中直接血管内治疗试验。急性前循环大血管闭塞患者在血栓切除术后48小时内根据CT或MRI检查分为3组：无颅内出血（无ICH）、aICH和有症状颅内出血（sICH）。主要结局是90天时的功能独立（定义为改良Rankin量表评分为0 - 2分）。次要结局是从基线到5 - 7天的美国国立卫生研究院卒中量表评分变化以及3个月死亡率。
本研究共纳入1177例患者（中位年龄68岁；男性占58.4%），包括818例无ICH患者、268例aICH患者和91例sICH患者。无ICH组的功能独立比例为57.3%，aICH组为34.7%，sICH组为3.3%。与无ICH组相比，aICH组（校正优势比[aOR]，0.40；95%置信区间0.29 - 0.55；P < 0.001）和sICH组（aOR，0.02；95%置信区间0.01 - 0.07；P < 0.001）的功能独立比例较低。aICH和sICH均与从基线到5 - 7天神经功能障碍改善较少以及90天死亡率较高相关。
在接受EVT的大血管闭塞性卒中患者中，aICH的存在与早期神经功能改善较少以及90天时残疾程度较高相关。应在EVT试验中评估无症状ICH，并研究减少无症状出血的策略。
