期刊
STROKE
卷 41, 期 12, 页码 2775-2781出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.110.587063
关键词
acute stroke; endovascular treatment; intra-arterial thrombolysis; mechanical thrombectomy; subarachnoid hemorrhage
资金
- NINDS NIH HHS [K23 NS054084, K23 NS054084-01A1] Funding Source: Medline
Background and Purpose-Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly and its impact on clinical outcome. Methods-Acute ischemic stroke patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis, or both were analyzed. Postprocedural computed tomography and magnetic resonance images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale score 3 hours after intervention and in the outcomes at discharge. Results-One hundred twenty-eight patients were treated by primary thrombectomy with MERCI Retriever devices, whereas 31 were treated by primary intra-arterial thrombolysis. Twenty patients experienced SAH, 8 with pure SAH and 12 with coexisting parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than in the intra-arterial thrombolysis groups (14.1% vs 6.5%, P=0.37). On multivariate analysis, independent predictors of SAH were hypertension (odds ratio=5.39, P=0.035), distal middle cerebral artery occlusion (odds ratio=3.53, P=0.027), use of rescue angioplasty after thrombectomy (odds ratio=12.49, P=0.004), and procedure-related vessel perforation (odds ratio=30.72, P<0.001). Patients with extensive SAH or coexisting parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% vs 0%, P=0.11), to be less independent at discharge (modified Rankin Scale <= 2; 0% vs 15.4%, P=0.5), and to experience higher mortality during hospitalization (42.9% vs 15.4%, P=0.29). Conclusions-Procedure-related vessel perforation, rescue angioplasty after thrombectomy with MERCI devices, distal middle cerebral artery occlusion, and hypertension were independent predictors of SAH after endovascular therapy for acute ischemic stroke. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge. (Stroke. 2010;41:2775-2781.)
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据