Abstract：
BACKGROUND: Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies.
OBJECTIVE: To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used.
METHODS: A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH.
RESULTS: The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other.
CONCLUSIONS: Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT.
BACKGROUND: Clinical trial NCT03845491.
OBJECTIVE: To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used.
METHODS: A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH.
RESULTS: The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other.
CONCLUSIONS: Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT.
BACKGROUND: Clinical trial NCT03845491.
摘要：
背景：很少有临床研究对用于治疗急性缺血性卒中的机械血栓切除术（MT）后颅内出血（ICH）的亚型进行详细分析。症状性颅内出血（sICH）是MT的严重并发症，在临床试验中被广泛用作安全性结果。然而,在临床研究中使用sICH的变量定义.
目的：对这一大型队列中MT后ICH的发展进行影像学分类，并检查与sICH的重叠。第二,检查sICH定义与当地站点报告的sICH发生的一致性，以了解sICH比率如何随着所使用定义的修改而变化。
方法：分析了大量接受MT治疗的急性缺血性卒中患者（n=1395），以（1）影像学表征MT后发生的颅内出血（ICH）的出血亚型；（2）检查出血亚型与sICH的相关性；（3）比较实验室判定的sICH的核心发生率与现场报告的sICH。
结果：ICH的总发生率为552/1395例（39.6%），sICH的总发生率为47/1395(3.4%)。最常见的ICH类型是出血性梗死1型（HI1），占所有ICH病例的45.3％-其次是HI2（31.5％）和蛛网膜下腔出血（SAH，29.2%）。实质血肿2（PH2）仅占所有ICH病例的3.3％。在PH2出血中，只有33.3%被确定为有症状.在sICH案件中，最常见的ICH亚型是HI2(48.9%)和SAH(38.3%).通过核心实验室裁定与当地现场报告的结果确定的sICH率的比较表明，只有14名患者被确定为两种定义的sICH。根据一个定义，共有47名患者患有sICH，但不是另一个。
结论：本分析的结果证明了ICH的影像学亚型，并强调了用于定义sICH的可变标准的局限性。建议重新审视MT后如何定义sICH可能是合适的。
背景：临床试验NCT03845491。
目的：对这一大型队列中MT后ICH的发展进行影像学分类，并检查与sICH的重叠。第二,检查sICH定义与当地站点报告的sICH发生的一致性，以了解sICH比率如何随着所使用定义的修改而变化。
方法：分析了大量接受MT治疗的急性缺血性卒中患者（n=1395），以（1）影像学表征MT后发生的颅内出血（ICH）的出血亚型；（2）检查出血亚型与sICH的相关性；（3）比较实验室判定的sICH的核心发生率与现场报告的sICH。
结果：ICH的总发生率为552/1395例（39.6%），sICH的总发生率为47/1395(3.4%)。最常见的ICH类型是出血性梗死1型（HI1），占所有ICH病例的45.3％-其次是HI2（31.5％）和蛛网膜下腔出血（SAH，29.2%）。实质血肿2（PH2）仅占所有ICH病例的3.3％。在PH2出血中，只有33.3%被确定为有症状.在sICH案件中，最常见的ICH亚型是HI2(48.9%)和SAH(38.3%).通过核心实验室裁定与当地现场报告的结果确定的sICH率的比较表明，只有14名患者被确定为两种定义的sICH。根据一个定义，共有47名患者患有sICH，但不是另一个。
结论：本分析的结果证明了ICH的影像学亚型，并强调了用于定义sICH的可变标准的局限性。建议重新审视MT后如何定义sICH可能是合适的。
背景：临床试验NCT03845491。
