Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke

被引:316
作者
Hao, Yonggang [1 ,2 ]
Yang, Dong [3 ]
Wang, Huaiming [3 ,4 ]
Zi, Wenjie [5 ]
Zhang, Meng [7 ]
Geng, Yu [8 ]
Zhou, Zhiming [9 ]
Wang, Wei [10 ]
Xu, Haowen [11 ]
Tian, Xiguang [12 ]
Lv, Penghua [13 ]
Liu, Yuxiu [6 ]
Xiong, Yunyun [5 ]
Liu, Xinfeng [1 ,3 ,5 ]
Xu, Gelin [1 ,3 ,5 ]
机构
[1] Southern Med Univ Guangzhou, Jinling Hosp, Dept Neurol, Nanjing, Jiangsu, Peoples R China
[2] Soochow Univ, Affiliated Hosp 1, Dept Emergency Med, Suzhou, Jiangsu, Peoples R China
[3] Second Mil Med Univ, Jinling Hosp, Dept Neurol, Nanjing, Jiangsu, Peoples R China
[4] 89th Hosp Peoples Liberat Army, Dept Neurol, Weifang, Shandong, Peoples R China
[5] Nanjing Univ, Med Sch, Jinling Hosp, Dept Neurol, Nanjing, Jiangsu, Peoples R China
[6] Nanjing Univ, Med Sch, Jinling Hosp, Dept Med Stat, Nanjing, Jiangsu, Peoples R China
[7] Third Mil Med Univ, Daping Hosp, Res Inst Surg, Dept Neurol, Chongqing, Peoples R China
[8] Zhejiang Prov Peoples Hosp, Dept Neurol, Hangzhou, Zhejiang, Peoples R China
[9] Wannan Med Coll, Yijishan Hosp, Dept Neurol, Wuhu, Anhui, Peoples R China
[10] Yangzhou Univ, Peoples Hosp Yangzhou 1, Dept Radiol, Yangzhou, Jiangsu, Peoples R China
[11] Zhengzhou Univ, Affiliated Hosp 1, Dept Neurol, Zhengzhou, Peoples R China
[12] Chinese Armed Police Force, Guangdong Armed Police Corps Hosp, Dept Neurol, Guangzhou, Guangdong, Peoples R China
[13] Northern Jiangsu Peoples Hosp, Dept Intervent Radiol, Yangzhou, Jiangsu, Peoples R China
基金
中国国家自然科学基金;
关键词
collateral circulation; groin; intracranial hemorrhages; stroke; thrombectomy; HEALTH-CARE PROFESSIONALS; BRAIN-BARRIER BREAKDOWN; EARLY MANAGEMENT; THERAPY; THROMBECTOMY; ATHEROSCLEROSIS; REPERFUSION; MORTALITY; TRANSFORMATION; ASSOCIATION;
D O I
10.1161/STROKEAHA.116.016368
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice. Methods-Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH. Results-Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; P<0.001). On multivariate analysis, baseline neutrophil ratio > 0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.243.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of < 6 (OR, 2.27; 95% CI, 1.24-4.14), stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture > 270 minutes (OR, 1.70; 95% CI, 1.03-2.80), > 3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment. Conclusions-Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH.
引用
收藏
页码:1203 / +
页数:10
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