Marie K Luff, Nicole Khezri, Salvador Miralbes, Bharath Naravetla, Alejandro M Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan A McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Lori Lyn Price, Rishi Gupta, Markus A Möhlenbruch, David S Liebeskind
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引用次数: 0
Abstract
Background: Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies.
Objective: To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used.
Methods: A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH.
Results: The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other.
Conclusions: Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT.
背景：很少有临床研究对用于治疗急性缺血性卒中的机械取栓术（MT）后颅内出血（ICH）的亚型进行详细分析。无症状性颅内出血（sICH）是机械取栓术的一种严重并发症，在临床试验中被广泛用作安全性结果。然而，临床研究中对 sICH 的定义各不相同：目的：在这一庞大的队列中对MT后ICH的发生进行放射学细分，并研究其与sICH的重叠情况。其次，检查这一 sICH 定义与当地现场报告的 sICH 发生率的一致性，以了解修改所用定义后 sICH 发生率的变化情况：方法：对一大批接受MT治疗的急性缺血性卒中患者（n=1395）进行了分析，以(1)从影像学角度描述MT治疗后发生的颅内出血（ICH）的出血性亚型；(2)研究出血性亚型与sICH的关联；(3)比较核心实验室判定的sICH发生率与现场报告的sICH发生率：ICH总发生率为552/1395例（39.6%），sICH总发生率为47/1395例（3.4%）。最常见的 ICH 类型是 1 型出血性梗死（HI1），占所有 ICH 病例的 45.3%，其次是 HI2（31.5%）和蛛网膜下腔出血（SAH，29.2%）。实质性血肿 2（PH2）仅占所有 ICH 病例的 3.3%。在PH2出血中，只有33.3%被确定为无症状。在 sICH 病例中，最常见的 ICH 亚型是 HI2（48.9%）和 SAH（38.3%）。比较核心实验室判定的sICH率和当地现场报告的结果显示，只有14名患者在两种定义下都被确定为sICH，共有47名患者在一种定义下被确定为sICH，而在另一种定义下则未被确定为sICH：这项分析结果表明了ICH的影像学亚型，同时也强调了用于定义sICH的可变标准的局限性，表明在MT后重新审视如何定义sICH可能是合适的：临床试验 NCT03845491。
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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