Influencing factors of the outcome in patients with asymptomatic intracranial hemorrhage after endovascular therapy for large vessel occlusive stroke in anterior circulation
10.3760/cma.j.issn.1673-4165.2024.09.003
- VernacularTitle:血管内治疗后发生无症状颅内出血的前循环大血管闭塞性卒中患者转归的影响因素
- Author:
Jinrui LI
1
;
Jianxia KE
;
Xiaoli FU
;
Weicheng ZHENG
;
Zhu SHI
Author Information
1. 南阳市中心医院神经内科，南阳 473000
- Keywords:
Ischemic stroke;
Endovascular procedures;
Thrombectomy;
Intracranial hemorrhages;
Treatment outcome;
Risk factors
- From:
International Journal of Cerebrovascular Diseases
2024;32(9):654-660
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the influencing factors of the outcome in patients with asymptomatic intracranial hemorrhage (aICH) after endovascular therapy (EVT) for large vessel occlusive stroke in anterior circulation.Methods:Patients with large vessel occlusive stroke in anterior circulation underwent EVT at Dongguan People's Hospital from January 2019 to January 2023 were included retrospectively. According to the CT re-examination results within 72 hours after EVT and the changes in the National Institutes of Health Stroke Scale (NIHSS) score, the patients were divided into non-ICH group and aICH group. At 90 days after onset, the modified Rankin Scale was used to evaluate functional outcome, >2 points were defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent correlated factors for outcome. Results:A total of 173 patients who did not experience intracranial hemorrhage (ICH) or experienced aICH after EVT were enrolled, including 121 males (69.9%), median aged 64.0 years. Sixty-four patients (37.0%) developed aICH after EVT, of which 44 (68.8%) were hemorrhagic infarction (HI) and 20 (31.2%) were parenchymal hematoma (PH). The incidence of poor outcome in the ICH group was significantly higher than that in the non-ICH group (42.2% vs. 26.6%; χ2=4.472, P=0.034). In aICH patients with poor collateral circulation, the proportion of patients with poor outcome was significantly higher than in all non-ICH patients (68.7% vs. 26.6%; χ2=11.388, P<0.001), while there was no significant difference in the proportion of patients with poor outcome in the good collateral circulation group compared to all non-ICH patients (23.5% vs. 26.6%; χ2=0.072, P=0.788). In aICH patients, the proportion of PH (68.7% vs. 11.8%; χ2=14.561, P<0.001) and poor outcome (68.7% vs. 23.5%; χ2=7.209, P=0.027) in patients with poor collateral circulation were significantly higher than that of good collateral circulation. Multivariate logistic regression analysis showed that poor collateral circulation (odds ratio [ OR] 3.84; 95% confidence interval [ CI] 1.07-12.76; P=0.039), older age ( OR 1.07, 95% CI 1.02-1.11; P=0.004), unsuccessful recanalization ( OR 6.36, 95% CI 1.74-23.23; P=0.005) , and PH ( OR 6.14, 95% CI 1.83-20.58; P=0.003) were the independent risk factors for poor outcome in patients with aICH. Conclusions:Among patients who developed aICH after EVT, the proportion of patients with poor outcome in the good collateral circulation group is comparable to that in the non-ICH group, but the risks of PH and poor outcome are significantly increased in the poor collateral circulation group. Poor collateral circulation is an independent risk factor for poor outcome in patients with aICH after EVT for large vessel occlusive stroke in anterior circulation.
