Intracranial Hemorrhage in Patients With Stroke After Endovascular Treatment With or Without IV Alteplase

作者：Yu Zhou, Lei Zhang, Fabiano Cavalcante, Kentaro Suzuki, Kilian M. Treurniet, Bernard Yan, Peter Mitchell, Steven Bush, Urs Fischer, Johannes Kaesmacher, Jan Gralla, Daniel Strbian, Roman Rohner, Manon Kappelhof, Yvo B.W.E.M. Roos, Charles B.L.M. Majoie, Wenjie Zi, Qingwu Yang, Yong‐Wei Zhang, Yuji Matsumaru, Kazumi Kimura, Xiaofei Ye, Pengfei Yang, Jianmin Liu, IRIS collaborators, Raul G. Nogueira, Qingwu Yang, Fengli Li, Jiacheng Huang, Jiaxing Song, Hong Bo, Wenhuo Chen, Ya Peng, Hongxing Han, Liyong Zhang, Shouchun Wang, Qi Fang, Chenghua Xu, Yongxin Zhang, Zifu Li, Pengfei Xing, Hongjian Shen, Ping Zhang, Stephen Davis, Huy‐Thang Nguyen, Geoffrey A. Donnan, Xiaochuan Huo, Guangxian Nan, Andrew Bivard, Henry Ma, Vu Dang Luu, Bruce Campbell, Bart J. Emmer, Jonathan M. Coutinho, Natalie E. LeCouffe, Diederik W.J. Dippel, Aad van der Lugt, Vincent Costalat, Geert J. Lycklama, Jeannette Hofmeijer, Anouk van Norden, Toshiaki Otsuka, Masataka Takeuchi, Masafumi Morimoto, Ryuzaburo Kanazawa, Yohei Takayama, Yuki Kamiya, Keigo Shigeta, Seiji Okubo, Mikito Hayakawa, Christophe Cognard, Simon Jung, Marnat Gaultier, Igor Sibon, Romain Bourcier, Solène de Gaalon, Chrysanthi Papagiannaki, Margaux Lefebvre, David S. Liebeskind · 发表于：JAMA Neurology · 年份：2025 · DOI：10.1001/jamaneurol.2025.2610 · 被引用次数：14 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Venous Thromboembolism Diagnosis and Management

Importance: For patients with acute ischemic stroke due to anterior circulation large vessel occlusion and presenting directly to endovascular treatment (EVT)-capable centers, intravenous thrombolysis (IVT) before EVT raises concerns about intracranial hemorrhage (ICH), but details are not well understood. Objective: To determine the frequency and subtypes of ICH in patients treated with IVT plus EVT vs EVT alone and to determine the association between various ICH subtypes and patient functional outcomes. Data Sources: PubMed and MEDLINE were searched from database inception through March 9, 2023. Study Selection: Randomized clinical trials comparing EVT alone with IVT plus EVT for anterior circulation large vessel occlusion stroke were included. Data Extraction and Synthesis: Individual participant data were extracted following the Preferred Reporting Items for Systematic Review and Meta-Analyses of independent participant data (PRISMA-IPD) reporting guidelines. Data were pooled using a random-effects model. Data were analyzed between April 2024 and February 2025. Main Outcomes and Measures: The primary outcomes were ICH and its subtypes according to the Heidelberg Bleeding Classification (hemorrhagic infarction type 1 [HI1], hemorrhagic infarction type 2 [HI2], parenchymal hematoma type 1 [PH1], parenchymal hematoma type 2 [PH2], and others; symptomatic or asymptomatic ICH), which were evaluated using a mixed-model approach with multinomial or binary regression. Results: T...