无症状颅内出血与取栓后预后的关系：一项救援BT和DEVT试验的汇总分析

IF 3.2 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-07-16 DOI:10.1212/CPJ.0000000000200500

Lingyu Cai, Zhizhong Yan, Mohamad Abdalkader, Tianfang Li, Hongfei Sang, Yan Tian, Dongjing Xie, Maohua Li, Wei Jin, Gregory W Albers, Zhongming Qiu, Thanh N Nguyen, Qingwu Yang, Haojin Zhao, Shunfu Jiang

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引用次数: 0

摘要

背景与目的：出血转化是急性大血管闭塞性脑卒中血管内再通术后常见且严重的并发症。无症状颅内出血（aICH）对血管内取栓（EVT）后预后的影响仍有待阐明。方法：对2018年10月至2021年10月的RESCUE BT试验和2018年5月至2020年5月的大血管闭塞性脑卒中直接血管内治疗试验两项中国随机试验的个体患者数据进行汇总分析。根据取栓后48小时内CT或MRI检查将急性前循环大血管闭塞患者分为3组：无颅内出血（no-ICH）、aICH和症状性ICH （sICH）。主要终点是90天的功能独立性（定义为修改的Rankin量表评分0-2）。次要结果是NIH卒中量表评分从基线到5-7天和3个月死亡率的变化。结果：共1177例患者(中位年龄68岁；58.4%男性)纳入本研究，其中无脑出血患者818例，重度脑出血患者268例，重度脑出血患者91例。无脑出血组功能独立比例为57.3%，aICH组为34.7%，siich组为3.3%。与无脑出血组相比，急性脑出血组功能独立的比例较低(调整优势比[aOR]， 0.40；95% ci 0.29-0.55；p < 0.001)和sICH组(aOR, 0.02；95% ci 0.01-0.07；P < 0.001)。aICH和siich在距基线5-7天的神经功能障碍改善较少，90天的死亡率较高。讨论：在接受EVT的大血管闭塞性卒中患者中，aICH的存在与早期神经系统改善较少和90天时更大的残疾相关。应在EVT试验中评估无症状脑出血，并研究减少无症状出血的策略。

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Association Between Asymptomatic Intracranial Hemorrhage and Outcomes After Thrombectomy: A Pooled Analysis of the RESCUE BT and DEVT Trials.

Background and objectives: Hemorrhagic transformation is a prevalent and serious complication that frequently occurs after endovascular recanalization in acute large vessel occlusion stroke. The impact of asymptomatic intracranial hemorrhage (aICH) on outcomes after endovascular thrombectomy (EVT) remains to be elucidated.

Methods: This was a pooled analysis of individual patient data of 2 randomized trials in China, the RESCUE BT trial from October 2018 to October 2021 and the Direct Endovascular Treatment for Large Vessel Occlusion Stroke trial from May 2018 to May 2020. Patients with acute anterior circulation large vessel occlusion were categorized into 3 groups based on CT or MRI examination within 48 hours after thrombectomy: no intracranial hemorrhage (no-ICH), aICH, and symptomatic ICH (sICH). The primary outcome was functional independence (defined as modified Rankin Scale score of 0-2) at 90 days. Secondary outcomes were the change in NIH Stroke Scale score from baseline to 5-7 days and 3-month mortality.

Result: A total of 1,177 patients (median age, 68 years; 58.4% male) were included in this study, comprising 818 patients without ICH, 268 patients with aICH, and 91 patients with sICH. The proportion of functional independence was 57.3% in the no-ICH group, 34.7% in the aICH group, and 3.3% in the sICH group. Compared with the no-ICH group, there was a lower proportion of functional independence in the aICH group (adjusted odds ratio [aOR], 0.40; 95% CI 0.29-0.55; p < 0.001) and the sICH group (aOR, 0.02; 95% CI 0.01-0.07; p < 0.001). Both aICH and sICH were associated with less improvement of neurologic disability at 5-7 days from baseline and higher mortality at 90 days.

Discussion: Among patients with large vessel occlusion stroke who underwent EVT, the presence of aICH was associated with less early neurologic improvement and greater disability at 90 days. Asymptomatic ICH should be assessed in EVT trials, and strategies to reduce asymptomatic hemorrhage should be investigated.

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.