Radiologic Patterns of Intracranial Hemorrhage and Clinical Outcome after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Traial

Radiology 2021;300:402-409

Large vessel occlusion 의 재개통을 위한 endovascular treatment (EVT) 후 발생하는 intracranial hemorrhage 는 잘 알려진 complication 이다. Acute ischemic stroke 과 관련된 intracranial hemorrhage 를 구분하기 위한 방법 중, 영상 검사를 기반으로 한 Heidelberg bleeding classification 이 광범위하게 사용되고 있다. 

Figure E1: Exemplary cases of hemorrhage subtypes on 24h follow-up MRI (A-D) and NCCT (E-H). (A) and (E) show HI1, (B) and (F) show HI-2, (C) and (G) show PH1 and (D) and (H) show PH2.

저자들은 ESCAPE-NA1 Triald date 를 이용하여 image based intracranial hemorrhage (hemorrhage infarction type 1(HI1), hemorrhage infarction type 2(HI2), parenchymal hematoma type 1(PH1), parenchymal hematoma type 2(PH2)) 와 clinical outcome 과의 관련성을 분석하였다.

Acute large vessel occlusion 으로 EVT 를 시행한 환자 1097(mean age, 69 years ± 14 [standard deviation]; 551 men) 명의 결과를 분석하였고, 372(34%)의 환자에서 HI1 (126명, 36%), HI2 (108명,

31%), PH1 (72명, 21%), PH2 (37명, 11%)의 다양한 grade 의 intracranial hemorrhage 가 발생하였다. Intracranial hemorrhage 의 종류와 상관없이 intracranial hemorrhage 가 발생한 환자들은 Good outcome (mRS: 0-2, 90 day) 을 얻기가 상대적으로 어려웠고 (164 of 372 participants [44%] vs 500 of 720 [69%], respectively; P <, .01), intracranial hemorrhage 의 severity (hemorrhage infarction < parenchymal hematoma) 와 clinical outcome 간의 graded relationship 을 보였다.

 (Conclusion: Any degree of intracranial hemorrhage after endovascular treatment was seen in one-third of participants. A graded association existed between radiologic hemorrhage severity and outcome. Hemorrhagic infarction was not associated with outcome, whereas parenchymal hematoma was strongly associated with poor outcome, independent of infarct volume.)