Abstract：
OBJECTIVE: We aimed to investigate the impact of post-thrombectomy isolated subarachnoid hemorrhage (i-SAH) and other types of intracranial hemorrhage (o-ICH) on patient\'s neurological outcomes.
METHODS: Stroke data from 2018 to 2022 in a tertiary care center were retrospectively analyzed. Patients with large vessel occlusion from ICA to M2 branch were included. Post-thrombectomy intracranial hemorrhages at 24 h were categorized with Heidelberg Bleeding Classification. Neurological impairment of patients was continuously assessed at admission, at 24 h, 48 h and 72 h, and at discharge. Predictors of i-SAH and o-ICH were assessed.
RESULTS: 297 patients were included. i-SAH and o-ICH were found in 12.1% (36/297) and 11.4% (34/297) of patients. Overall, NIHSS of i-SAH patients at discharge were comparable to o-ICH patients (median 22 vs. 21, p = 0.889) and were significantly higher than in non-ICH patients (22 vs. 7, p < 0.001). i-SAH often resulted in abrupt deterioration of patient\'s neurological symptoms at 24 h after thrombectomy. Compared to non-ICH patients, the occurrence of i-SAH was frequently associated with worse neurological outcome at discharge (median NIHSS increase of 4 vs. decrease of 4, p < 0.001) and higher in-hospital mortality (41.7% vs. 23.8%, p = 0.022). Regardless of successful reperfusion (TICI 2b/3), the beneficial impact of thrombectomy appeared to be outweighed by the adverse effect of i-SAH. Incomplete reperfusion and shorter time from symptom onset to admission were associated with higher probability of i-SAH, whereas longer procedure time and lower baseline ASPECTS were predictive for o-ICH occurrence.
CONCLUSIONS: Post-thrombectomy isolated subarachnoid hemorrhage is a common complication with significant negative impact on neurological outcome.
METHODS: Stroke data from 2018 to 2022 in a tertiary care center were retrospectively analyzed. Patients with large vessel occlusion from ICA to M2 branch were included. Post-thrombectomy intracranial hemorrhages at 24 h were categorized with Heidelberg Bleeding Classification. Neurological impairment of patients was continuously assessed at admission, at 24 h, 48 h and 72 h, and at discharge. Predictors of i-SAH and o-ICH were assessed.
RESULTS: 297 patients were included. i-SAH and o-ICH were found in 12.1% (36/297) and 11.4% (34/297) of patients. Overall, NIHSS of i-SAH patients at discharge were comparable to o-ICH patients (median 22 vs. 21, p = 0.889) and were significantly higher than in non-ICH patients (22 vs. 7, p < 0.001). i-SAH often resulted in abrupt deterioration of patient\'s neurological symptoms at 24 h after thrombectomy. Compared to non-ICH patients, the occurrence of i-SAH was frequently associated with worse neurological outcome at discharge (median NIHSS increase of 4 vs. decrease of 4, p < 0.001) and higher in-hospital mortality (41.7% vs. 23.8%, p = 0.022). Regardless of successful reperfusion (TICI 2b/3), the beneficial impact of thrombectomy appeared to be outweighed by the adverse effect of i-SAH. Incomplete reperfusion and shorter time from symptom onset to admission were associated with higher probability of i-SAH, whereas longer procedure time and lower baseline ASPECTS were predictive for o-ICH occurrence.
CONCLUSIONS: Post-thrombectomy isolated subarachnoid hemorrhage is a common complication with significant negative impact on neurological outcome.
摘要：
目的：我们旨在研究血栓切除术后孤立性蛛网膜下腔出血(i-SAH)和其他类型颅内出血(o-ICH)对患者神经系统预后的影响。
方法：回顾性分析三级护理中心2018年至2022年的卒中数据。包括从ICA到M2分支的大血管闭塞的患者。血栓切除术后24小时颅内出血按海德堡出血分类。入院时持续评估患者的神经功能缺损，在24小时，48h和72h，在出院时。评估了i-SAH和o-ICH的预测因子。
结果：297例患者被纳入。在12.1%(36/297)和11.4%(34/297)的患者中发现i-SAH和o-ICH。总的来说,i-SAH患者出院时的NIHSS与o-ICH患者相当（中位数22vs.21，p=0.889），并且显着高于非ICH患者（22vs.7，p<0.001)。i-SAH常导致血栓切除术后24h患者的神经系统症状突然恶化。与非ICH患者相比，i-SAH的发生通常与出院时神经系统转归较差相关（NIHSS中位数增加4vs.降低4，p<0.001）和更高的住院死亡率（41.7%与23.8%,p=0.022)。无论再灌注是否成功（TICI2b/3），i-SAH的不良反应似乎超过了血栓切除术的有益影响.不完全的再灌注和从症状发作到入院的较短的时间与较高的i-SAH概率相关。而较长的手术时间和较低的基线ASPECTS可预测o-ICH的发生.
结论：血栓切除术后孤立性蛛网膜下腔出血是一种常见并发症，对神经系统预后有显著的负面影响。
方法：回顾性分析三级护理中心2018年至2022年的卒中数据。包括从ICA到M2分支的大血管闭塞的患者。血栓切除术后24小时颅内出血按海德堡出血分类。入院时持续评估患者的神经功能缺损，在24小时，48h和72h，在出院时。评估了i-SAH和o-ICH的预测因子。
结果：297例患者被纳入。在12.1%(36/297)和11.4%(34/297)的患者中发现i-SAH和o-ICH。总的来说,i-SAH患者出院时的NIHSS与o-ICH患者相当（中位数22vs.21，p=0.889），并且显着高于非ICH患者（22vs.7，p<0.001)。i-SAH常导致血栓切除术后24h患者的神经系统症状突然恶化。与非ICH患者相比，i-SAH的发生通常与出院时神经系统转归较差相关（NIHSS中位数增加4vs.降低4，p<0.001）和更高的住院死亡率（41.7%与23.8%,p=0.022)。无论再灌注是否成功（TICI2b/3），i-SAH的不良反应似乎超过了血栓切除术的有益影响.不完全的再灌注和从症状发作到入院的较短的时间与较高的i-SAH概率相关。而较长的手术时间和较低的基线ASPECTS可预测o-ICH的发生.
结论：血栓切除术后孤立性蛛网膜下腔出血是一种常见并发症，对神经系统预后有显著的负面影响。
