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The related main theme: A. Stroke and Cerebral vascular disorders

中國醫藥大學附設安南醫院急性腦中風動脈取栓術後症狀性腦出血危險因子分析

Risk factor analysis of symptomatic brain hemorrhage after Intra-arterial thrombectomy for acute ischemic stroke in An Nan hospital, China Medical University

Authers:

李建欣, MD 1 , 張哲肇, MD 1 , 蔡銘駿, PhD, MD 1, 2, 3 , 
Chien-Hsin   Li, MD 1 , Che-Chao  Chang, MD 1 , Ming-Jun  Tsai, PhD, MD 1, 2, 3 , 
1 中國醫藥大學附設安南醫院
2 中國醫藥大學醫學院醫學系
3 中國醫藥大學附設醫院
1 An Nan Hospital, China Medical University
2 School of medicine, Medical college, China Medical Univeristy
3 China Medical University Hospital
Corresponding Author:

蔡銘駿
Ming-Jun  Tsai , PhD, MD
中國醫藥大學附設安南醫院
An Nan Hospital, China Medical University

keywords: intra-arterial thrombectomy, brain hemorrhage, ischemic stroke
Abstract for original article

OBJECTIVES /BACKGROUND:
On time restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for saving ischemic brain tissue that is still not infarcted. Since 2015, mechanical thrombectomy (IA) has been proposed by AHA/ASA for patients with acute ischemic stroke secondary to a large artery occlusion in selected cases, regardless of previous intravenous alteplase for the same acute ischemic stroke. There is relatively narrow window for mechanical thrombectomy this can be accomplished, because the benefit of reperfusion rapidly diminished over time. Symptomatic brain hemorrhage is the major poor outcome for mechanical thrombectomy, and here we analyzed the risk factor of symptomatic brain hemorrhage secondary to mechanical thrombectomy in An Nan Hospital.

MATERIAL and METHOD:
24 hour mechanical thrombectomy for acute ischemic stroke is available in An Nan hospital since 2019.10. Patients suffering from symptomatic brain hemorrhage secondary to IA in our hospital were included, and the control is all patients receiving IA without significant side effects. Basic patient information, stroke pattern, initial NIHSS, ASPECTS before IA, onset to needle time, recanalization rate (TICI) and co-morbidity were analyzed between the symptomatic brain hemorrhage group and the control.

RESULT:
Three patients had symptomatic brain hemorrhage after IA. The Mean age of symptomatic brain hemorrhage patients including two female and one male is 75.3 y/o, and the mean age of the control is 74.6 y/o (n=18). All symptomatic brain hemorrhage patients were ICA occlusion (two left ICA and one right ICA), and 11% (2/18) of the control is ICA occlusion (P<0.001). Mean onset to needle time of symptomatic brain hemorrhage patients are 357.3 minutes and the control is 387.6 minutes. Re-canalization rate (TICI=3 or 2b) is 100% in the symptomatic brain hemorrhage group and however, only 72% re-canalization rate is available in the control. All symptomatic brain hemorrhage patients (100%) have initial NIHSS≧30 or ASPECTS≧8, whereas, the control is only 11% (2/18) (P<0.001).

DISCUSSION:
Symptomatic brain hemorrhage secondary to mechanical thrombectomy is devastating outcome of IA. In An Nan hospital one year experience, we found symptomatic hemorrhage after IA is strongly associated with ICA occlusion and high initial NIHSS (≧30) or ASPECTS (≧8) before IA.


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