Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke: analysis of 64 cases

Lin CHEN; Guangjian LI; Qu LIU; Zhenhua ZHOU; Kangning CHEN; Rujiancai GU; Hong RAN

doi:10.16016/j.1000-5404.202104045

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Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke: analysis of 64 cases

Neurosciences | 更新时间：2026-01-09

- Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke: analysis of 64 cases
- Journal of Third Military Medical University Vol. 43, Issue 15, Pages: 1471-1476(2021)
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院神经内科
  2.850000 拉萨，西藏军区总医院神经内科
- 作者简介：
- 基金信息：
  
  the Project of Basic Research and Frontier Exploration of Chongqing(cstc2018jcyjAX0203)
- DOI：10.16016/j.1000-5404.202104045
  CLC： R741.05;R743.31;R743.34
- Received：08 April 2021，
  
  Revised：2021-06-06，
  
  Published：15 August 2021
- 稿件说明：
移动端阅览
Lin CHEN, Guangjian LI, Qu LIU, et al. Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke: analysis of 64 cases[J]. Journal of Third Military Medical University, 2021, 43(15): 1471-1476.
DOI：

Lin CHEN, Guangjian LI, Qu LIU, et al. Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke: analysis of 64 cases[J]. Journal of Third Military Medical University, 2021, 43(15): 1471-1476. DOI： 10.16016/j.1000-5404.202104045.

摘要

目的

探讨急性缺血性卒中血管内治疗后实质性出血(parenchymal hemorrhage，PH)2型颅内出血(intracerebral hemorrhage，ICH)的影响因素。

方法

纳入2020年4-12月在陆军军医大学第一附属医院神经内科住院且行血管内治疗的急性缺血性卒中患者共计64例。根据术后72 h内头颅CT判断患者是否存在PH2型颅内出血。回顾分析病例资料，包括年龄、性别、高血压病、糖尿病、高脂血症、冠心病、房颤、卒中史、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale，NIHSS)评分、血压、血糖、糖化血红蛋白、血小板、国际标准化比值(INR)、心源性栓塞、术前抗栓治疗、术前静脉溶栓、阿尔伯塔脑卒中计划早期诊断评分(Alberta Stroke Program Early CT Score，ASPECTS)等信息。

结果

纳入的64例患者均经过血管内治疗，术后72 h内诊断为ICH有28例(28/64，43.8%)，其中PH2型ICH有9例(9/64，14.1%)。PH2组血糖(中位数，7.50

6.58 mmol/L，

=0.039)、女性比例(77.8%

38.2%，

=0.035)、心源性栓塞比例(88.9%

49.1%，

=0.033)显著高于非PH2组；ASPECTS(中位数，6

7，

=0.026)、ASPECTS＞6分的比例(22.2%

63.6%，

=0.029)显著低于非PH2组。其中，血糖升高是发生PH2型颅内出血的危险因素(

=1.48；95%

=1.00~2.18)。

结论

急性缺血性卒中患者血糖升高可能增加血管内治疗后发生PH2型颅内出血的风险。

Abstract

Objective

To investigate the influencing factors of intracranial hemorrhage (ICH) of parenchymal hemorrhage type 2 (PH2) after endovascular treatment (EVT) in patients with acute ischemic stroke (AIS).

Methods

A total of 64 AIS patients who were admitted to the First Affiliated Hospital of Army Medical University and received endovascular treatment from April 1

2020 to December 31

2020 were enrolled in this study

and the presence of PH2 ICH was determined by cranial CT scanning within 72 h after operation. The clinical data of the patients were collected and retrospectively reviewed

including age

gender

hypertension

diabetes

hyperlipidemia

coronary heart disease

atrial fibrillation

stroke history

National Institutes of Health Stroke Scale (NIHSS) score

blood pressure

blood glucose

glycosylated hemoglobin

platelet

international normalized ratio (INR)

cardiogenic embolism

preoperative antithrombotic therapy

preoperative intravenous thrombolysis

and Alberta Stroke Program Early CT Score (ASPECTS).

Results

Among all the 64 patients

28 cases (28/64

43.8%) were diagnosed with ICH within 72 h after surgery

among which 9 cases (9/64

14.1%) had PH2 ICH. In the PH2 group

the median blood glucose (7.50

6.58

=0.039)

proportion of women (77.8%

38.2%

=0.035)

and proportion of cardiogenic embolism (88.9%

49.1%

=0.033) were significantly higher

whereas the median ASPECTS (6

=0.026) and proportion of ASPECTS

6 (22.2% vs 63.6%

=0.029) were greatly lower than those of the non-PH2 group. In addition

the increased blood glucose presented as a risk factor for the occurrence of PH2 ICH (

=1.48

95%

: 1.00~2.18).

Conclusion

Elevated blood glucose may increase the risk of developing PH2 ICH after EVT in patients with AIS.

关键词

Keywords

references

JOVINT G, CHAMORRO A, COBO E, et al . Thrombectomy within 8 hours after symptom onset in ischemic stroke[J ] . N Engl J Med, 2015, 372(24): 2296-2306. DOI:10.1056/nejmoa1503780.

GOYAL M, DEMCHUKA M, MENONB K, et al . Randomized assessment of rapid endovascular treatment of ischemic stroke[J ] . N Engl J Med, 2015, 372(11): 1019-1030. DOI:10.1056/NEJMoa1414905.

CAMPBELLB C, MITCHELLP J, KLEINIGT J, et al . Endovascular therapy for ischemic stroke with perfusion- imaging sele ction[J ] . N Engl J Med, 2015, 372(11): 1009-1018. DOI:10.1056/nejmoa1414792.

BERKHEMERO A, FRANSENP S, BEUMER D, et al . A randomized trial of intraarterial treatment for acute ischemic stroke[J ] . N Engl J Med, 2015, 372(1): 11-20. DOI:10.1056/nejmoa1411587.

SAVERJ L, GOYAL M, BONAFE A, et al . Stent-retriever thrombectomy after intravenous t-PA vs . t-PA alone in stroke[J ] . N Engl J Med, 2015, 372(24): 2285-2295. DOI:10.1056/nejmoa1415061..

耿皓东, 后显华, 陈康宁. 急性后循环大血管闭塞性脑卒中血管内治疗疗效与安全性的真实世界多中心回顾性研究[J]. 第三军医大学学报, 2021, 43(6): 534-540. DOI:10.16016/j.1000-5404.202012132.

GENG H D, HOU X H, CHEN K N. Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study[J]. J Third Mil Med Univ, 2021, 43(6): 534-540. DOI:10.16016/j.1000-5404.202012132.

JIA B, REN Z, MOKIN M, et al . Current status of endovascular treatment for acute large vessel occlusion in China: areal-world nationwide registry[J ] . Stroke, 2021, 52(4): 1203-1212. DOI:10.1161/strokeaha.120.031869.

BRACARD S, DUCROCQ X, MASJ L, et al . Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial[J ] . Lancet Neurol, 2016, 15(11): 1138-1147. DOI:10.1016/S1474-4422(16)30177-6.

HAO Y G, YANG D, WANG H M, et al . Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke[J ] . Stroke, 2017, 48(5): 1203-1209. DOI:10.1161/STROKEAHA.116.016368.

HACKE W, KASTE M, FIESCHI C, et al . Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke the european cooperative acute stroke study (ECASS)[J ] . JAMA, 1995, 274(13): 1017-1025.

FIORELLI M, BASTIANELLO S, VON KUMMER R, et al . Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort[J ] . Stroke, 1999, 30(11): 2280-2284. DOI:10.1161/01.str.30.11.2280.

BERGER C, FIORELLI M, STEINER T, et al . Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic?[J ] . Stroke, 2001, 32(6): 1330-1335. DOI:10.1161/01.str.32.6.133 0.

ZHANG X H, XIE Y, WANG H M, et al . Symptomatic intracranial hemorrhage after mechanical thrombectomy in Chinese ischemic stroke patients: the ASIAN score[J ] . Stroke, 2020, 51(9): 2690-2696. DOI:10.1161/STROKEAHA.120.030173.

GOYAL M, MENONB K, VAN ZWAMW H, et al . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J ] . Lancet, 2016, 387(10029): 1723-1731. DOI:10.1016/s0140-6736(16)00163-x.

中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性脑梗死后出血转化诊治共识2019[J]. 中华神经科杂志, 2019, 52(04): 252-265. DOI:10.3760/cma.j.issn.1006-7876.2019.04.003.

Neurology Society of Chinese Medical Association, Cerebrovascular Goup of Neurology Society of Chinese Medical Association. Consensus on diagnosis and treatment of hemorrhagic transformation after acute ischemic stroke in China 2019[J]. Chin J Neurol, 2019, 52(04): 252-265. DOI:10.3760/cma.j.issn.1006-7876.2019.04.003.

WAHLGREN N, AHMED N, ERIKSSON N, et al . Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST)[J ] . Stroke, 20 08, 39(12): 3316-3322. DOI:10.1161/STROKEAHA.107.510768.

MONTALVO M, MISTRY E, CHANGA D, et al . Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score[J ] . J Neurol Neurosurg Psychiatry, 2019, 90(12): 1370-1374. DOI:10.1136/jnnp-2019-321184.

SUGIURA Y, YAMAGAMI H, SAKAI N, et al . Predictors of symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke with large vessel occlusion[J ] . J Stroke Cerebrovasc Dis, 2017, 26(4): 766-771. DOI:10.1016/j.jstrokecerebrovasdis.2016.10.015.

CHAMORRO A, BROWN S, AMARO S, et al . Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke: a pooled-data meta-analysis[J ] . Stroke, 2019, 50(3): 690-696. DOI: 10.1161/STROKEAHA. 118.023769.

ZANG L, ZHANG D, YAO Y Y, et al . Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: a systematic review and meta-analysis[J ] . Am J Emerg Med, 2021, 45: 23-28. DOI:10.1016/j.ajem.2021.02.032.

LUG D, RENZ Q, ZHANGJ X, et al . Effects of diabetes mellitus and admission glucose in patients receiving mechanical thrombectomy: a systematic review and meta-analysis[J ] . Neurocrit Care, 2018, 29(3): 426-434. DOI:10.1007/s12028-018-0562-4.

HAO Z, YANG C, XIANG L, et al . Risk factors for intracranial hemorrhage after mechanical thrombectomy: a systematic review and meta-analysis[J ] . Expert Rev Neurother, 2019, 19(10): 927-935. DOI:10.1080/14737175. 2019.1632191.

AHMED N, DÁVALOS A, ERIKSSON N, et al . Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR)[J ] . Arch Neurol, 2010, 67(9): 1123-1130. DOI:10.1001/archneurol.2010.210.

LI F F, REN Y, CUI X Y, et al . Postoperative hyperglycemia predicts symptomatic intracranial hemorrhage after endovascular treatment in patients with acute anterior circulation large artery occlusion[J ] . J Neurol Sci, 2020, 409: 116588. DOI:10.1016/j.jns.2019.116588.

DIETRICHW D, ALONSO O, BUSTO R. Moderate hyperglycemia worsens acute blood-brain barrier injury after forebrain ischemia in rats[J]. Stroke, 1993, 24(1): 111-116. DOI:10.1161/01.str.24.1.111.

DESILLESJ P, SYVANNARATH V, OLLIVIER V, et al . Exacerbation of thromboinflammation by hyperglycemia precipitates cerebral infarct growth and hemorrhagic transformation[J ] . Stroke, 2017, 48(7): 1932-1940. DOI:10.1161/strokeaha.117.017080.

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