Risk factors for intracranial hemorrhage after mechanical thrombectomy: a systematic review and meta-analysis

<b>Background</b>: Intracerebral hemorrhage (ICH) is the most feared complication of mechanical thrombectomy (MT). This study aims to provide a comprehensive overview of ICH risk factors. <b>Methods</b>: The authors systematically searched Pubmed and Embase (from inception to November 2018) for studies evaluating independent predictors for symptomatic ICH (sICH), parenchymal hematoma (PH), hemorrhagic infarction (HI), and any ICH after MT. <b>Results</b>: This analysis included a total of 42 studies involving 10,001 patients. The combined rate was 8% (7–10%) for sICH, 13% (10–15%) for PH, 25% (20–29%) for HI, and 35% (31–39%) for any ICH. Meta-analysis identified the following predictors of sICH: female sex (OR 2.98, 95%CI 1.23–7.25, I² = 26.3%), treatment interval (OR 1.01, 95%CI 1–1.03, I² = 69.20%), tirofiban use (OR 3.16, 95%CI 2.11–4.73, I² = 0%), and ASPECTS score on admission (OR 0.63, 95%CI 0.54–0.74, I² = 0%). Predictors of any ICH were diabetes mellitus (OR 1.95, 95%CI 1.29–2.94, I² = 35.7%), deep white matter on diffusion-weighted imaging (OR 3.11, 95%CI 1.56–6.20, I² = 0%), and intravenous recombinant tissue plasminogen activator (rt-PA) (OR 2.57, 95%CI 1.28–5.17, I² = 0%). <b>Conclusion</b>: Many predictors of ICH were identified, however, given the lack of robust evidence, larger cohort studies should be prioritized to confirm these predictors.

<b>研究背景</b>：脑出血（Intracerebral hemorrhage, ICH）是机械取栓术（mechanical thrombectomy, MT）最凶险的并发症。本研究旨在全面综述脑出血的危险因素。<b>研究方法</b>：研究者系统检索了PubMed和Embase数据库（建库至2018年11月），筛选评估机械取栓术后症状性脑出血（symptomatic ICH, sICH）、脑实质血肿（parenchymal hematoma, PH）、出血性脑梗死（hemorrhagic infarction, HI）及各类脑出血的独立预测因素的相关研究。<b>研究结果</b>：本荟萃分析共纳入42项研究，涉及10001例患者。汇总数据显示，症状性脑出血发生率为8%（95%CI：7%~10%），脑实质血肿为13%（95%CI：10%~15%），出血性脑梗死为25%（95%CI：20%~29%），各类脑出血总体发生率为35%（95%CI：31%~39%）。荟萃分析明确了症状性脑出血的以下独立预测因素：女性性别（OR=2.98，95%CI：1.23~7.25，I²=26.3%）、治疗间隔时间（OR=1.01，95%CI：1~1.03，I²=69.20%）、替罗非班（tirofiban）使用（OR=3.16，95%CI：2.11~4.73，I²=0%）及入院时阿尔伯塔卒中项目早期CT评分（ASPECTS score）（OR=0.63，95%CI：0.54~0.74，I²=0%）。各类脑出血的独立预测因素包括：糖尿病（diabetes mellitus）（OR=1.95，95%CI：1.29~2.94，I²=35.7%）、弥散加权成像显示的深部白质病变（OR=3.11，95%CI：1.56~6.20，I²=0%）及静脉重组组织型纤溶酶原激活剂（intravenous recombinant tissue plasminogen activator, rt-PA）输注（OR=2.57，95%CI：1.28~5.17，I²=0%）。<b>研究结论</b>：本研究已明确多种脑出血相关预测因素，但鉴于现有证据强度不足，未来应优先开展大规模队列研究以验证上述预测因子。