Asymptomatic Intracerebral Hemorrhage May Worsen Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy
Asymptomatic Intracerebral Hemorrhage May Worsen Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy
复制标题
无症状脑出血可能会使接受血栓切除术的急性缺血性中风患者的临床结果恶化
DOI：
10.1016/j.jstrokecerebrovasdis.2019.02.006
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发表时间：
2019-06-01
影响因子：
2.5
通讯作者：
Ji, Xunming
中科院分区：
文献类型：
--
作者：
Jiang, Fang;Zhao, Wenbo;Ji, Xunming
背景：无症状脑出血（AICH）是接受血管内血栓切除术（ET）治疗的急性缺血性卒中（AIS）患者的常见现象。本研究旨在评估 AICH 的临床效果及其危险因素。方法：这项观察性研究基于前瞻性登记研究。招募了前循环大血管闭塞并接受 ET 治疗的 AIS 患者。在血栓切除术中，动脉内输注溶栓剂或抗血小板药物以及永久性支架置入术作为补救疗法。主要结果是 ET 后 90 天改良 Rankin 量表 (mRS) 的总体分布。结果：本研究纳入 102 名患者（61.1 +/- 12.7 岁），其中 39 名患者（38.2%）经历过 AICH。在 90 天的随访中，无 AICH 患者的中位 mRS 为 2（四分位距 [IQR] 0-3），患有 AICH 的患者为 4（IQR 2-6）（调整后的 P=0.005）。 14 名 AICH 患者和 7 名非 AICH 患者死亡，差异显着（35.9% vs 11.1%，调整后 P=0.015）。 39 名未患 AICH 的患者 (61.9%) 和 14 名患有 AICH 的患者 (35.9%) 在 3 个月的随访中实现了功能独立（调整后的 P=0.117）。无 AICH 患者的重症监护病房住院时间为 5 天 (IQR 2-10)，患有 AICH 的患者为 8 天 (IQR 3-19)（调整后的 P=.840）。在多变量分析中，较低的阿尔伯塔中风计划早期 CT 评分 (ASPECTS)（调整后的 P=0.003）和辅助动脉内溶栓（调整后的 P=0.016）与 AICH 独立相关。结论：在 AIS 患者中，接受 ET AICH 治疗似乎与较差的功能结果和高死亡率相关。较低的 ASPECTS 和形容词动脉内溶栓是 AICH 的独立危险因素。
Background: Asymptomatic intracerebral hemorrhage (AICH) is a common phenomenon in patients with acute ischemic stroke (AIS) who were treated with endovascular thrombectomy (ET). This study aimed to evaluate the clinical effects of AICH and its risk factors in this patient population. Methods: This observational study was based on a prospective registry study. AIS patients with large-vessel occlusion in the anterior circulation and treated with ET were recruited. During thrombectomy procedures, intra-arterial infusion of thrombolytics or antiplatelet and permanent stenting were used as remedial therapies. The primary outcome was the overall distribution of modified Rankin scale (mRS) 90 days after ET. Results: This study included 102 patients (61.1 +/- 12.7 years old), in whom 39 patients (38.2%) experienced AICH. At 90-day follow-up, the median mRS was 2 (interquartile range [IQR] 0-3) for patients without AICH and 4 (IQR 2-6) for those with AICH (adjusted P=.005). Fourteen patients with AICH and 7 patients without AICH died, which was significantly different (35.9% versus 11.1%, adjusted P=.015). Thirty-nine patients (61.9%) without AICH and 14 patients (35.9%) with AICH achieved functional independence at 3-month follow-up (adjusted P=.117). The length of intensive care unit staying was 5 days (IQR 2-10) in patients without AICH and 8 days (IQR 3-19) in those with AICH (adjusted P=.840). In multivariate analysis, lower Alberta Stroke Program Early CT Score (ASPECTS) (adjusted P=.003) and adjunctively intra-arterial thrombolysis (adjusted P=.016) were independently associated with AICH. Conclusions: In AIS patients treated with ET AICH appears to be associated with worse functional outcomes and high mortality. Lower ASPECTS and adjectively intra-arterial thrombolysis were independent risk factors of AICH.