Supplementary Material for: Risk of Intracranial Hemorrhage after Endovascular Treatment for Acute Ischemic Stroke: Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Intracranial hemorrhage is a major complication of endovascular treatment in patients with acute ischemic stroke. Controlled clinical trials reported varied incidences of intracranial hemorrhage after endovascular treatment. This meta-analysis aimed to estimate whether endovascular treatment, compared with medical treatment, increases the risk of intracranial hemorrhage in patients with acute ischemic stroke. <b><i>Methods:</i></b> The current publications on endovascular treatment for acute ischemic stroke were systematically reviewed. Rates of intracranial hemorrhage after endovascular treatment for acute ischemic stroke reported in controlled clinical trials were pooled and analyzed. Random and fixed-effect models were used to pool the outcomes. For analyzing their individual risks, intracranial hemorrhages after endovascular treatment were classified as symptomatic and asymptomatic. <b><i>Results:</i></b> Eleven studies involving 1,499 patients with endovascular treatment and 1,320 patients with medical treatment were included. After pooling the data, the risk of any intracranial hemorrhage was significantly higher in patients with endovascular treatment than in patients with medical treatment (35.0 vs. 19.0%, OR = 2.55, 95% CI: 1.64-3.97, <i>p &lt; </i>0.00001). The risk of asymptomatic intracranial hemorrhage was also significantly higher in patients with endovascular treatment than in those with medical treatment (28 vs. 12%, OR = 3.16, 95% CI: 1.62-6.16, <i>p </i>&lt; 0.001). However, the risks of symptomatic intracranial hemorrhage were similar in patients with endovascular treatment and in those with medical treatment (5.6 vs. 5.2%, OR = 1.09, 95% CI: 0.79-1.50, <i>p</i> = 0.61). <b><i>Conclusion:</i></b> Although the risk of any intracranial hemorrhage may increase after endovascular treatment, the risk of symptomatic intracranial hemorrhage may remain similar as compared with medical treatment.

<b><i>背景：</i></b> 颅内出血（Intracranial hemorrhage）是急性缺血性卒中（acute ischemic stroke）患者接受血管内治疗（endovascular treatment）后的主要并发症。已有对照临床试验（controlled clinical trials）报道了血管内治疗后颅内出血发生率存在差异。本荟萃分析（meta-analysis）旨在评估与药物治疗相比，血管内治疗是否会升高急性缺血性卒中患者的颅内出血风险。<b><i>方法：</i></b> 本研究对当前已发表的急性缺血性卒中血管内治疗相关文献进行了系统回顾。对对照临床试验中报道的急性缺血性卒中患者接受血管内治疗后的颅内出血发生率进行合并分析。采用随机效应模型（random-effect model）与固定效应模型（fixed-effect model）合并结局指标。为分析不同类型颅内出血的风险，将血管内治疗后的颅内出血分为症状性颅内出血（symptomatic intracranial hemorrhage）与无症状性颅内出血（asymptomatic intracranial hemorrhage）两类。<b><i>结果：</i></b> 本研究共纳入11项研究，涉及1499例接受血管内治疗的患者与1320例接受药物治疗的患者。合并数据后显示，血管内治疗组患者的任意颅内出血风险显著高于药物治疗组（35.0% vs. 19.0%，比值比（Odds Ratio，OR）=2.55，95%置信区间（Confidence Interval，CI）：1.64~3.97，p<0.00001）。血管内治疗组患者的无症状性颅内出血风险同样显著高于药物治疗组（28% vs. 12%，OR=3.16，95%CI：1.62~6.16，p<0.001）。但两组患者的症状性颅内出血风险无显著差异（5.6% vs. 5.2%，OR=1.09，95%CI：0.79~1.50，p=0.61）。<b><i>结论：</i></b> 尽管血管内治疗可能升高患者的任意颅内出血风险，但与药物治疗相比，其症状性颅内出血风险并无明显变化。