血管内卒中血栓切除术后再灌注成功并伴有症状性颅内出血（sICH）与再灌注不成功但无颅内出血：两项随机试验的事后分析

IF 4.5 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2025-02-13 DOI:10.1136/jnis-2024-022869

Yanling Li, Yusi Fu, Xinggang Feng, Lve Chen, Shiwei Luo, Shunfu Jiang, Huiyuan Peng, Xianjun Huang, Wensheng Zhang, Yihong Huang, Min Zhang, Genpei Luo, Fukui Ge, Jing Xu, Hanning Huang, Min Guan, Zhenze Chen, Wenjie Zi, Qingwu Yang, Hongfei Sang, Zhongming Qiu, Mingchao Li, Thanh N Nguyen, Zhenqiang Zhao, Wei Li

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Patients with AIS who underwent EVT were categorized into two groups according to the state of reperfusion: eTICI 2b-3 with sICH and eTICI 0-2a without sICH. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. The safety outcomes included early neurological deterioration and 90-day mortality.Results: 161 patients were included in this cohort analysis, among whom 71 experienced eTICI 2b-3 with sICH, and 90 had eTICI 0-2a without sICH. After adjusting for potential confounding factors, patients in the eTICI 2b-3 with sICH group had worse mRS at 90 days compared with those in the eTICI 0-2a without sICH group in the adjusted analysis (median 6 (IQR 4-6) vs median 4 (IQR 3-6); adjusted common OR 0.39, 95% CI 0.17 to 0.66). 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引用次数: 0

摘要

背景：对接受血管内治疗（EVT）成功再灌注（脑梗死扩大溶栓（eTICI） 2b-3）合并症状性颅内出血（sICH）的急性缺血性卒中（AIS）大血管闭塞（LVO）患者的功能结局与再灌注失败（eTICI 0-2a）无sICH患者进行比较。根据再灌注状态将行EVT的AIS患者分为eTICI 2b-3伴sICH组和eTICI 0-2a无sICH组。主要终点是90天时的改良Rankin量表（mRS）评分。安全性结果包括早期神经功能恶化和90天死亡率。结果：本队列分析纳入161例患者，其中伴有sICH的eTICI 2b-3有71例，无sICH的eTICI 0-2a有90例。在对潜在的混杂因素进行校正后，在校正分析中，eTICI 2b-3合并siich组患者在90天的mRS较eTICI 0-2a无siich组患者更差(中位数为6 (IQR 4-6) vs中位数为4 (IQR 3-6)；校正普通OR 0.39, 95% CI 0.17至0.66)。极差预后的发生率也较高(mRS 5-6, 70.4% vs 42.2%；OR 2.90, 95% CI 1.38 - 6.11)，死亡率(66.2% vs 32.2%；OR 0.48, 95% CI 0.30 - 0.79)和早期神经功能恶化(81.7% vs 40.0%；与eTICI 0-2a无sICH组相比，eTICI 2b-3合并sICH组的OR为0.16,95% CI为0.07至0.35)。结论：EVT后再灌注成功并颅内出血与再灌注不成功且无颅内出血相比，预后更差，死亡率更高。这些发现强调需要在评估和管理evt后相关的siich方面做出更多努力，以优化治疗策略并改善结果。试验注册号：直接血管内治疗大血管闭塞性卒中；https://www.chictr.org.cn;chictr - ior - 17013568。急性缺血性脑卒中血管内取栓前静脉注射替罗非班https://www.chictr.org.cn;chictr -印度卢比17014167。

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Successful reperfusion accompanied by symptomatic intracranial hemorrhage (sICH) versus unsuccessful reperfusion without sICH after endovascular stroke thrombectomy: a post-hoc analysis of two randomized trials.

Background: Functional outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) with successful reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b-3) complicated by symptomatic intracranial hemorrhage (sICH) were compared with patients with unsuccessful reperfusion (eTICI 0-2a) without sICH.

Methods: Patients enrolled in this post hoc analysis were from two Chinese multicenter, randomized controlled trials: the DEVT and the RESCUE BT registries. Patients with AIS who underwent EVT were categorized into two groups according to the state of reperfusion: eTICI 2b-3 with sICH and eTICI 0-2a without sICH. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. The safety outcomes included early neurological deterioration and 90-day mortality.

Results: 161 patients were included in this cohort analysis, among whom 71 experienced eTICI 2b-3 with sICH, and 90 had eTICI 0-2a without sICH. After adjusting for potential confounding factors, patients in the eTICI 2b-3 with sICH group had worse mRS at 90 days compared with those in the eTICI 0-2a without sICH group in the adjusted analysis (median 6 (IQR 4-6) vs median 4 (IQR 3-6); adjusted common OR 0.39, 95% CI 0.17 to 0.66). There were also higher rates of very poor outcome (mRS 5-6, 70.4% vs 42.2%; OR 2.90, 95% CI 1.38 to 6.11), mortality (66.2% vs 32.2%; OR 0.48, 95% CI 0.30 to 0.79), and early neurological deterioration (81.7% vs 40.0%; OR 0.16, 95% CI 0.07 to 0.35) in the eTICI 2b-3 with sICH group versus the eTICI 0-2a without sICH group.

Conclusions: Successful reperfusion complicated by sICH after EVT was associated with worse outcomes and higher mortality than unsuccessful reperfusion without sICH. These findings emphasize the need for additional efforts in assessing and managing post-EVT-associated sICH to optimize treatment strategies and improve outcomes.

Trial registration number: Direct Endovascular Treatment for Large Vessel Occlusion Stroke; https://www.chictr.org.cn; ChiCTR-IOR-17013568.Intravenous Tirofiban Before Endovascular Thrombectomy for Acute Ischemic Stroke; https://www.chictr.org.cn; ChiCTR-INR-17014167.

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

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.