Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy.
Predictors of subarachnoid hemorrhage in acute ischemic stroke with endovascular therapy.
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DOI：
10.1161/strokeaha.110.587063
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发表时间：
2010-12
期刊：
影响因子：
8.3
通讯作者：
UCLA Endovascular Stroke Therapy Investigators
中科院分区：
文献类型：
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作者：
Shi ZS;Liebeskind DS;Loh Y;Saver JL;Starkman S;Vespa PM;Gonzalez NR;Tateshima S;Jahan R;Feng L;Miller C;Ali LK;Ovbiagele B;Kim D;Duckwiler GR;Viñuela F;UCLA Endovascular Stroke Therapy Investigators
蛛网膜下腔出血(SAH)是血管内再通术后潜在的出血性并发症。这项研究的目的是描述血管内治疗的急性缺血性中风患者SAH的频率和预测因素，以及它对临床结果的影响。对接受直接机械取栓、动脉内溶栓(IAT)或两者同时治疗的急性缺血性中风(AIS)患者进行分析。术后复查CT和MR图像以确定SAH的存在。我们评估了干预后3小时美国国立卫生研究院卒中量表(NIHSS)评分的任何下降以及出院时的结果。128例患者采用Merci Retriver装置行直接取栓治疗，31例患者行直接腔内支架植入术。20例患者经历了SAH-8例单纯SAH，12例合并实质性出血。与IAT组相比，直接取栓组SAH的发生率更高(14.1%比6.5%，p=0.37)。多因素分析显示，高血压(OR5.39；p=0.035)、大脑中动脉远端闭塞(OR3.53；p=0.027)、血栓摘除后行补救性血管成形术(OR12.49；p=0.004)、手术相关血管穿孔(OR30.72；p<；0.001)是蛛网膜下腔出血的独立预测因素。广泛蛛网膜下腔出血或合并实质性血肿的患者倾向于在3小时内有更多的神经恶化(28.6%比0%；p=0.11)，出院时独立性较差(改良Rankin评分≤2，0%比15.4%；p=0.5)，以及更常在住院期间死亡(42.9%比15.4%；p=0.29)。手术相关血管穿孔、Merci装置血栓摘除后的抢救性血管成形术、大脑中动脉远端闭塞和高血压是血管内治疗AIS后SAH的独立预测因素。只有广泛的SAH或SAH合并严重的实质性血肿可能会在出院时恶化临床结果。
Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly, and its impact on clinical outcome. Acute ischemic stroke (AIS) patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis (IAT), or both were analyzed. Post-procedural CT and MR images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale (NIHSS) score 3 hours post-intervention and outcomes at discharge. One hundred twenty-eight patients were treated by primary thrombectomy with Merci Retriever devices, while 31 were treated by primary IAT. Twenty patients experienced SAH- eight with pure SAH, and twelve with co-existing parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than IAT groups (14.1% versus 6.5%, p=0.37). On multivariate analysis, independent predictors of SAH were hypertension (OR 5.39; p=0.035), distal middle cerebral artery (MCA) occlusion (OR 3.53; p=0.027), use of rescue angioplasty after thrombectomy (OR 12.49; p=0.004), and procedure-related vessel perforation (OR 30.72; p<0.001). Patients with extensive SAH or co-existing parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% versus 0%; p=0.11), to be less independent at discharge (modified Rankin Scale ≤ 2, 0% versus 15.4%; p=0.5); and to more often die during hospitalization (42.9% versus 15.4%; p=0.29). Procedure-related vessel perforation, rescue angioplasty after thrombectomy with Merci devices, distal MCA occlusion, and hypertension were independent predictors of SAH following endovascular therapy for AIS. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.