Prognostic implications of intracranial haemorrhage on dual-energy CT immediately following endovascular treatment for acute ischemic stroke

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology Pub Date : 2023-11-19 DOI:10.1016/j.neurad.2023.11.003

Florentina M.E. Pinckaers , Magretha M.Q. Robbe , Susanne G.H. Olthuis , Hieronymus D. Boogaarts , Wim H. van Zwam , Robert J. van Oostenbrugge , Alida A. Postma

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引用次数: 0

Abstract

Objective

To describe the incidence, risk factors, and prognostic relevance of intracranial haemorrhage (ICH) immediately after endovascular treatment (EVT) for ischaemic stroke in the anterior circulation.

Methods

EVT records from 2010 to 2019 were screened. Included patients underwent DECT within 3h post-EVT. Virtual native reconstructions were evaluated for ICH according to the Heidelberg criteria and grouped into Heidelberg classes (HCs): [HC1] haemorrhagic infarction (HI)1, HI2 and parenchymal haematoma (PH)1; [HC2] PH2; [HC3] i.a. intraventricular and subarachnoid haemorrhage. If ICH corresponding to multiple HCs was observed, we assumed that the (largest) parenchymal ICH would have the greatest prognostic impact. Hence, a single HC was attributed by the following order of severity: HC2, HC1, HC3. The primary outcome was the modified Rankin Scale (mRS) at 90 days. The effect of asymptomatic ICH (aICH) and symptomatic ICH (sICH) of (1) HC1 or HC2 and (2) HC3 on patient outcomes was evaluated with multivariable regression after multiple imputation.

Results

Out of 651 records, 498 patients were included. Eighty-one (16%) patients showed ICH on post-EVT DECT, of which 19 were classified as HC1 (21% symptomatic), 6 as HC2 (100% symptomatic), and 56 as HC3 (14% symptomatic). ICH development was mainly associated with unfavourable procedural characteristics. Both aICH and sICH of HC1 or HC2 were associated with the mRS (aICH: adjusted [a]cOR 4.92, 95%CI [1.48–16.35]; sICH: acOR 12.97, 95%CI [2.39–70.26]) and mortality (aICH: aOR 10.08, 95%CI [2.48–40.88]; sICH: aOR 9.92, 95%CI [1.48–66.31]). Likewise, sICH of HC3 was associated with the mRS and mortality (acOR 19.91, 95%CI [4.03–98.35], and aOR 13.23, 95%CI [2.27–77.18], respectively). aICH of HC3 was not significantly associated with the mRS or mortality (acOR 0.87, 95%CI [0.48–1.57], and cOR 0.84, 95%CI [0.32–2.20], respectively).

Conclusions

Immediate post-EVT ICH is a frequent finding. Except for aICH of HC3, any ICH is associated with poor long-term clinical outcomes.

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急性缺血性脑卒中血管内治疗后立即颅内出血的双能CT预后意义。

目的:探讨前循环缺血性卒中血管内治疗(EVT)后立即颅内出血(ICH)的发生率、危险因素及预后相关性。方法:筛选2010-2019年EVT记录。纳入的患者在evt后3小时内接受了DECT。根据Heidelberg标准评估ICH的虚拟原生重建，并将其分为Heidelberg分类(hc): [HC1]出血性梗死(HI)1, HI2和实质血肿(PH)1;(HC2) PH2;[HC3]即脑室内和蛛网膜下腔出血。如果观察到多种hcc对应的脑出血，我们认为(最大的)实质脑出血将对预后产生最大的影响。因此，单个HC按严重程度排序为:HC2、HC1、HC3。主要观察指标为90天的改良Rankin量表(mRS)。采用多变量回归法评估(1)HC1或HC2和(2)HC3的无症状性脑出血(aICH)和症状性脑出血(sICH)对患者预后的影响。结果:651例病例中，纳入498例患者。81例(16%)evt后DECT显示脑出血，其中HC1 19例(21%有症状)，HC2 6例(100%有症状)，HC3 56例(14%有症状)。ICH的发展主要与不利的程序特征有关。HC1或HC2的aICH和sICH均与mRS相关(aICH:调整后[a] or 4.92, 95%CI [1.48 ~ 16.35];脑出血:acOR 12.97, 95%CI[2.39 ~ 70.26])和死亡率(aICH: aOR 10.08, 95%CI [2.48 ~ 40.88];sICH: aOR 9.92, 95%CI[1.48 ~ 66.31])。同样，HC3的sICH与mRS和死亡率相关(acOR分别为19.91,95%CI[4.03-98.35]和13.23,95%CI[2.27-77.18])。HC3的aICH与mRS和死亡率无显著相关性(acOR分别为0.87,95%CI [0.48 ~ 1.57]， cOR为0.84,95%CI[0.32 ~ 2.20])。结论:evt后立即发生脑出血是常见的发现。除了h3的急性脑出血外，任何脑出血都与不良的长期临床结果相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroradiology 医学-核医学

CiteScore

6.10

自引率

5.70%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.

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