| Research Background:Acute ischemic stroke is one of the main causes of death and disability in the world,among them,acute Ischemic Stroke with Large Vessel Occlusion(AIS-LVO)is the most dangerous and prognostic type.In 1995,the NINDS trial confirmed that intravenous injection of recombinant tissue plasminogen activator(rt-PA)within a 3-hour time after the onset of symptoms in patients with acute cerebral infarction can reduce the related morbidity and mortality.In an analysis of 53 studies,the overall recanalization rate of intravenous thrombolysis in the early stage of acute cerebral infarction was 46.2%,while the overall recanalization rate of AIS-LVO was less than 30%.Since 2015,after five independent randomized controlled studies published in the New England Journal of Medicine,mechanical thrombectomy provides a higher recanalization rate for AIS-LVO,up to more than 80%.However,regardless of the treatment method,hemorrhagic transformation after reperfusion treatment is one of the most likely complications to cause disability and death in patients with AIS-LVO;there are significant differences in its incidence and related research reports;there are still disputes about the imaging differences,risk factors and pathogenesis after HT;which need further discussion.Objective: To explore the conversion rate of intracerebral hemorrhage,the related risk factors of hemorrhagic transformation(HT)and parenchymal hematoma-2(PH2)in patients with AIS-LVO after intravenous thrombolysis and bridging therapy,and to provide some reference significance for clinical work.Method: 1.Retrospective analysis was conducted from April 2016 to July 2022 in the Stroke Center of Dalian Medical University and Dalian Central Hospital,by cranial CT,cranial CTA and/or MRA and/or DSA confirmed AIS-LVO.A total of 319 hospitalized patients who underwent intravenous thrombolysis or bridging therapy,they were divided into simple intravenous thrombolysis group and bridging group according to whether mechanical thrombectomy was performed(among them,178 cases in the simple intravenous thrombolysis group and 141 cases in the bridging treatment group).According to whether there was cerebral hemorrhage transformation on cranial CT scan 24 hours after treatment in the two groups,they were divided into non-HT group and HT group,and then according to Heidelberg classification,HT group was divided into three groups: HT-1 group,PH2 group and HT-3 group.The following information was also collected: age,sex,history of drinking and smoking,history of hypertension,history of diabetes,atrial fibrillation,coronary heart disease history,stroke history,fasting blood glucose,total cholesterol(TC),low-density lipoprotein(LDL),white blood cell(WBC)count,neutrophil percentage(NEU%),plasma D-dimer,APTT,INR,responsible occlusion of blood vessels,whether there is white matter demyelination,the number of times of embolectomy,duration of operation,whether to use tirofiban during and after surgery ASPECT score,onset-to treatment time(OTT),door-to-needle time(DNT),NIHSS score at the time of hospital visit,24-hour variability in blood pressure,etc.2.The incidence of HT,HT-1,PH2 and HT-3 at 24 hours after simple intravenous thrombolysis group and the bridging group was statistically collected.3.Simple intravenous thrombolytic group:(1)Statistical analysis and comparison whether there are statistical differences in natural history,personal history,disease history,biochemical indicators,imaging performance and and other related indexes in non-HT group and the HT group;(2)Statistical analysis and comparison whether there are statistical differences in natural history,personal history,disease history,biochemical indicators,imaging performance and and other related indexes in HT-1,PH2 and HT-3 groups.4.Bridging treatment group:(1)Statistical analysis and comparison whether there are statistical differences in natural history,personal history,disease history,biochemical indicators,imaging performance and and other related indexes in non-HT group and the HT group;(2)statistical analysis and comparison whether there are statistical differences in natural history,personal history,disease history,biochemical indicators,imaging performance and and other related indexes in HT-1,PH2 and HT-3 groups.5.The factors P<0.05 in the single factor analysis were taken into the multivariate logistic regression model to analyze the possible independent risk factors of HT and PH2 in the simple intravenous thrombolysis group and the bridging treatment group.6.The patients with HT,HT-1 and PH2 were compared between the intravenous thrombolysis group and the bridging treatment group in terms of natural history,personal history,disease history,biochemical indicators,imaging performance and other relevant indicators.Outcome:1.Hemorrhage transformation rate: In simple intravenous thrombolysis group,the conversion rate of cerebral hemorrhage 24 hours after operation was 27.53%,of which the incidence of HT-1 was 14.04%,the incidence of PH2 was 10.11%,and the incidence of HT-3 was 3.37%;In the bridging treatment group,the conversion rate of intracerebral hemorrhage 24 hours after operation was 36.88%,of which the incidence of HT-1 was 21.99%,the incidence of PH2 was 12.06%,and the incidence of HT-3 was 2.84%;there was no significant difference between the two groups in the incidence of HT(P>0.05),and no significant difference in the distribution of HT classification(HT-1,PH2 and HT-3)(P>0.05).2.Intra-group comparison of simple intravenous thrombolysis:(1)Comparison between groups with and without HT(non HT and HT)in the simple intravenous thrombolysis group: there were significant differences in age,drinking history,smoking history,fasting blood glucose,D-dimer,NIHSS score at the time of admission and blood pressure variability(P<0.01);there were statistical differences in gender and DNT(P<0.05).(2)Comparison of three different types of bleeding(HT-1,PH2,HT-3)in the simple intravenous thrombolysis group: there were significantly different in TC,LDL(P<0.01);there were different in age,D-dimer,NEU%,white matter demyelination and blood pressure variability(P<0.05).3.Intra-group comparison of bridging treatment group:(1)Comparison between groups with and without HT(non HT and HT)in the bridging treatment group: there was significant difference in fasting blood glucose(P<0.01);there was statistical difference in blood pressure variability(P<0.05).(2)Comparison of three different types of bleeding(HT-1,PH2,HT-3)in the bridging treatment group: there were significant differences in NIHSS score,D-dimer and operation duration at the time(P<0.01).4.In the simple intravenous thrombolysis group: the occurrence of HT and PH2 were taken as dependent variables,and the factors P<0.05 in the univariate analysis were taken as independent variables into the binary logistic multivariate regression equation,in which age,D-dimer,DNT and NIHSS score in the hospital may be independent risk factors for the occurrence of HT(P<0.05);age,D-dimer,NEUT% and blood pressure variability may be independent risk factors for PH2(P<0.05).5.In the bridging treatment group:the occurrence of HT and PH2 were taken as the dependent variables,and the factors P<0.05 in the univariate analysis were taken as the dependent variables into the binary logistic multivariate regression equation,in which fasting blood glucose and blood pressure variability were independent risk factors for the occurrence of HT(P<0.01);NIHSS score in the hospital may be an independent risk factor for PH2(P<0.05).6.Comparison of the occurrence of HT,HT-1 and PH2 between the intravenous thrombolysis group and the bridging treatment group:(1)Comparison between intravenous thrombolysis group and bridging treatment group with postoperative HT: there were significant differences in age,smoking history and stroke history(P<0.01);there weret differences in sex and drinking history(P<0.05).(2)Comparison between intravenous thrombolysis group and bridging treatment group with postoperative HT-1: there was significant difference in the history of stroke(P<0.01);there was difference in smoking history(P<0.05).(3)Comparison between intravenous thrombolysis group and bridging treatment group with postoperative PH2: there were significant differences in age and history of stroke 、 demyelination of white matter(P<0.01);there were differences in history of drinking and smoking(P<0.05).Conclusion:1.There was no difference in the incidence of HT and the distribution of HT classification between the intravenous thrombolysis group and the bridging treatment group at 24 hours after operation.2.Simple intravenous thrombolytic group: elderly age,increased D-dimer,prolonged DNT and high NIHSS score at the time of admission may be independent risk factors for HT;elderly age,elevated D-dimer,elevated NEU% and high variability of blood pressure may be independent risk factors for PH2.3.In the bridging treatment group: high fasting blood glucose and high variability of blood pressure may be independent risk factors for HT;higher NIHSS score at the time of admission may be an independent risk factor for PH2.4.Compared with intravenous thrombolysis,the patients with HT after bridging therapy are younger,and the proportion of male,drinking history,smoking history and stroke history is higher;the patients with HT-1 after bridging therapy have a higher proportion of smoking history and stroke history;the patients with PH2 after bridging therapy are young and have a low proportion of demyelination in white matter,but the proportion of drinking history,smoking history and stroke history is higher. |
