Chen Huanwen, McIntyre Matthew K, Malhotra Ajay, Gandhi Dheeraj, Colasurdo Marco
Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA.
J Neurol. 2025 Jul 27;272(8):540. doi: 10.1007/s00415-025-13282-y.
The safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with underlying unruptured intracranial aneurysms (UIAs) is unclear. This study evaluates IVT safety and efficacy in AIS patients with UIAs in routine clinical practice.
Using the 2016-2022 Nationwide Readmissions Database, we conducted a retrospective cohort study of AIS patients with National Institutes of Health Stroke Scale (NIHSS) scores ≥ 6. Patients with a diagnosis of UIA were identified. Patients with intracranial tumors and other cerebrovascular malformations were excluded. Multivariable logistic regression assessed the association between IVT and outcomes, including routine discharge, mortality, subarachnoid hemorrhage (SAH), and intraparenchymal hemorrhage (IPH). Interaction analyses compared treatment effects between UIA and non-UIA patients.
Of 689,285 AIS patients, 11,687 (1.7%) had UIAs; 25.0% received IVT. Among UIA patients, IVT was associated with higher rates of routine discharge [adjusted OR (aOR) 2.25 (95%CI 1.95-2.59)] and lower mortality [aOR 0.64 (95%CI 0.48-0.87)]. IVT did not increase SAH risk in UIA patients [aOR 0.97 (95%CI 0.63-1.49)]. IVT was linked to higher IPH risk for UIA patients [aOR 1.34 (95%CI 1.06-1.70)], though this association was also found among non-UIA patients with a similar magnitude (p-interaction = 0.91). Compared to IVT-treated non-UIA patients, IVT-treated UIA patients were significantly more likely to experience routine discharge [OR 1.20 (95%CI 1.02-1.40)], despite having significantly higher odds of SAH [OR 1.97 (95%CI 1.19-3.26)].
Among AIS patients with UIAs, IVT was associated with better functional outcomes without excess risk of SAH. UIAs do not significantly alter the risk profile of IVT treatment.
急性缺血性卒中（AIS）合并未破裂颅内动脉瘤（UIA）患者进行静脉溶栓（IVT）的安全性尚不清楚。本研究评估了常规临床实践中AIS合并UIA患者进行IVT的安全性和有效性。
利用2016 - 2022年全国再入院数据库，我们对美国国立卫生研究院卒中量表（NIHSS）评分≥6分的AIS患者进行了一项回顾性队列研究。确定诊断为UIA的患者。排除颅内肿瘤和其他脑血管畸形患者。多变量逻辑回归评估IVT与结局之间的关联，包括常规出院、死亡率、蛛网膜下腔出血（SAH）和脑实质内出血（IPH）。交互分析比较了UIA患者和非UIA患者的治疗效果。
在689,285例AIS患者中，11,687例（1.7%）患有UIA；25.0%接受了IVT。在UIA患者中，IVT与更高的常规出院率相关[调整后比值比（aOR）2.25（95%置信区间1.95 - 2.59）]和更低的死亡率相关[aOR 0.64（95%置信区间0.48 - 0.87）]。IVT并未增加UIA患者发生SAH的风险[aOR 0.97（95%置信区间0.63 - 1.49）]。IVT与UIA患者发生IPH的风险较高相关[aOR 1.34（95%置信区间1.06 - 1.70）]，尽管在非UIA患者中也发现了类似程度的关联（p交互作用 = 0.91）。与接受IVT治疗的非UIA患者相比，接受IVT治疗的UIA患者更有可能实现常规出院[比值比1.20（95%置信区间1.02 - 1.40）]，尽管发生SAH的几率显著更高[比值比1.97（95%置信区间1.19 - 3.26）]。
在AIS合并UIA的患者中，IVT与更好的功能结局相关，且无SAH的额外风险。UIA不会显著改变IVT治疗的风险概况。
